STUDY ON IMPACT OF ICDS IN KARNATAKA
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- Title
- STUDY ON IMPACT OF ICDS IN KARNATAKA
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STUDY ON IMPACT OF ICDS IN KARNATAKA
Client
UNICEF, Hyderabad
Dept of Women and Child Development
Karnataka, Bangalore
JN
27004
i I
PROJECT DETAILS
Project Title
:
Study sponsored by
Research Team
Impact of ICDS in Karnataka
UNICEF Hyderabad
Dept of Women and Child Development,
Govt, of Karnataka, Bangalore
:
Mr Tilak Mukherji
Dr U V Somayajulu
MODE Research Pvt LfcL, Hyderabad
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FOREWORD
Integrated Child Development Sendees (ICDS), launched in 1975 in 33 blocks
of the country on experimental basis, is one of the largest and most unique
outreach programmes for early childhood care and development ICDS is a
powerful outreach programme designed to promote holistic development of
children under six years, helps in achieving major national nutrition and health
goals listed in tire National Plan of Action for children, 1992.
In Karnataka, ICDS has been in operation for more than two decades, and
provides a package of services which includes Suppiementaty nutrition.
Immunisation, Health checkups. Referral services. Preschool Education and
Nutation and Health Education (through house visits and group sessions).
In Karnataka, an innovative refresher training programme aimed at enabling the
AWWs to respond to die emerging programme thrusts, was experimented. Tlte
main features of the innovative refresher training programme include
participatory approach, field level staff playing the role of trainers,
decentralisation of field based training and team building, and focus on joint
analysis of field situation and experiences.
The present study commissioned by UNICEF, Hyderabad and Dept, of Women
and Child Development, Bangalore, is aimed at assessing the impact of the
ICDS programme with specific reference to tire innovative refresher training
imparted to die AWWs.
The study has been earned out in 80 projects/blocks across the state of
Karnataka (covering ail the districts) with the target group being functionaries
of ICDS and health department, mothers, community leaders, Ztlla/Taluk
Panchayat Presidents, Chief Executive Officers and senior district officials
(AD/PO).
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Field work for the study was conducted
during December 1997-
Februaxy 1998. At various stages of the study, we received full cooperation
and support from UNICEF Hyderabad and Department of Women and Child
Development, Government of Karnataka, Bangalore. Particularly we wish to
thank Sri S C Bhargava, Dr.S K Charturvedi, Sri Muchandi and Dr Deepika of
UNICEF and Smt. Lata Krishna Rao, IAS, Sri Shankar Narayans, Ms Prema
Kumari, Ms Banu of the DWCD, Bangalore for their unlimited support,
cooperation, suggestions and guidance at every stage of the study.
The field work could be completed smoothly due to die cooperation and
support extended by the government officials / functionaries at state, district,
block and sector level. We wish to thank them all.
We wish to extend our gratitude to all the respondents - mothers, community
leaders, AWWs and other functionaries - for sparing valuable time to provide
the information needed to achieve the objectives of the study.
Authors
MODE Research Pvt Ltd
Hyderabad
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CONTENTS
■1
Page No.
I.
1.1
1.2
INTRODUCTION
ICDS
Innovative Refresher Training
1
2
7
2.
OBJECTIVES
9
3.
METHODOLOGY
Sampling Design
Coverage
Research Methods
Field Operations
Data Analysis
II
14
15
16
ANGANWADI WORKER
17
Profile
18
Job Performance
19
3.1
3.2
3.3
3.4
3.5
4.
4.1
4.2
5.
5.1
5.3
5.4
6.
6.1
6.2
6.3
6.4
6.5
HEALTH AND NUTRITION STATUS OF CHILDREN
BELOW 6 YRS
Immunisation
Referral Services
Nutrition Status of Children
Growth Monitoring
PRE SCHOOL EDUCATION
Actual Performance (Scanning of Records)
Pre School Sessions - AWW’s Stated Response
Pre School Attendance of Child (Mother’s Response)
Use of Integrated Approach
Schooling Status of Children
12
13
23
24
26
28
30
34
35
37
39
42
43
Page No.
7.
WOMEN’S KNOWLEDGE & AWARENESS OF
HEALTH & CHILD CARE PRACTICES
Immunisation
Health Checkups
Referral Services
Treatment of Minor Ailments
Supplementary Feeding
Growth Monitoring
45
46
49
50
50
51
52
8.1
8.2
8.3
8.4
8.5
UTILISATION OF SERVICES BY MOTHERS AND
CHILDREN
Immunisation
Health Checkups
Growth Monitoring
Supplementary Food (Mothers)
Supplementary Food - Children
54
55
60
63
65
68
9.
CONVERGENCE OF SERVICES
70
10.
10.1
10.2
COMMUNITY PARTICIPATION
AWW’s Response
Mother’s Response
74
75
78
11.
11.1
11.2
11.3
11.4
11.5
OTHER ISSUES
Nutrition and Health Education - House Visits
NHED Group Sessions
Infant and Child Deaths
Recording Work
Supervision
81
82
86
91
92
96
12
12.1
12.2
CONCLUSIONS AND SUGGESTIONS
Conclusions
Suggestions
99
100
103
7.1
7.2
7.3
7.4
7.5
7.6
8.
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LIST OF TABLES
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Table
Ncl Title
3.2a
Coverage
13
Ala
4.2a
Background Characteristics of AWWs
Activities Supposed to be Carried Out (Stated response of
AWWs)
20
5.1 a
5.2a
5.3a
5.4a
Immunisaiion Coverage
No. of Children Referred
Distribution of Children by Age and Nutrition Grade (As per
records)
Growth Monitoring
21
25
27
29
32
6.1a No. of days Pre School Held and Attendance
6.2a Pre School Sessions - AWW’s Response
6.3a Pre School Awareness & Attendance (Mother’s Response)
6.5a Schooling Status of Children of 6-14 yeans
36
38
40
43
7.1a
7.1b
7.2a
7.5a
7.6a
Awareness about Child Immunisation among Mothers
Awareness about TT among Mothers
Awareness of Health Checkups
Awareness about Supplementary Food
Awareness about Periodic Weighing
47
48
49
51
52
8.1a
8.1b
8.1c
8.2a
8.3a
8.4a
8.5a
Immunisation Received by Child
No. of doses received
TT Injection
Health Checkups - Details
Child Weighing Practice
Supplementary Food Utilisation by Pregnant Women
Supplementary Food Utilisation by Children
56
58
59
62
64
67
68
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MOM.
Table
No, Title
10.1 a Activities1 in which CL, Mother and MMM help
10.2a Involvement of Mothers
11.1 a
Il.Ib
11.1c
11.2a
11.2b
11.2c
11.2d
11.3a
11.4a
11.4b
11.5a
House Visits (AWW’s Response)
Details about last visit (AWW’s Response)
House Visits (Mothers’s Response)
NITED Sessions (AWW’s Response)
Use of AV Aids by AWWs
NHED Sessions by AWWs
Use of Aids (Mother’s Response)
Reduction in Infant and Child Deaths (1996-1997)
Awareness about Registers
Maintenance of Registers
Visits by Supervisors (AWW’s Response)
/Page
No,
76
78
83
84
85
87
87(i)
89
90
91
93
94
97
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LIST OF FIGURES
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Fig No. Title
.
Page No.
4.1
4.2
4.3
Caste Distribution of AWWs
Education Status of AWWs
Age Distribution of AWWs
20a
20b
20c
5.1
5.2
5.3
5.4
5.5
Immunisation Coverage
Pulse Polio Coverage
Nutrition Status of Infants
Nutrition Status of Children (0-6 years)
Last Weighing of Children (0-6 years)
25a
25b
29a
29b
32a
6.1
6.2
6.3
6.4
No. of Days Pre School Held
Ability to Organise Pre School
Pre School Attendance
Schooling Status of Children of 6-14 years in the
Household
36a
38a
40a
43a
7.1
7.2
7.3
Awareness about Child Immunisation
Awareness about Health Checkups
Awareness about Growth Monitoring
47a
49a
52a
8.1
8.2
8.3
8.4
8.5
8.6
56a
59a
62a
64a
64b
8.7
Immunisation Received by Child
TT Injection (Pregnant Women)
Health Checkups (Pregnant Women)
Post Weighing Interaction (AWW-Mother)
No. of Times Weighed (Last 1 year)
Supplementary Food UtiHsatian by Pregnant Women
(Last Pregnancy)
Suppl. Food Utilisation by Children
10.1
10.2
Community Participation
Mothers Involvement
76a
78a
11.1
11.2
Frequency of House Visits by AWWs
Houses Given Priority by AWWs
n i
11. j
Frequency of NHED Sessions
83a
83 b
87a
11.4
Last NHJ3E> Sea Mans
67b
11.5
Registers Maintained by AWWs
94 a
67a
68a
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■ 1
CHAPTER -1
INTRODUCTION
41
2
ICDS
■ ;
Integrated Child Development Services (ICDS), launched m 1975 in 33 blocks of
die country on experimental basis, is one of the largest and most unique outreach
programmes for early childhood care and development. With a recognition that
early childhood development constitutes the foundation of human development,
ICDS is designed so as to promote holistic development of children under six
years.
ICDS is a powerful outreach programme which helps in achieving the major
national nutrition and health goals listed in the National Plan of Action for
Children, 1992. The programme contributes to the national goal of universal
primary education also through early childhood education.
ICDS provides increased opportunities to promote early development, associated
with improved enrollment, retention in the early primary stage and by releasing the
girl children from the burden of care of siblings which enables them to get the
benefit of primary education.
Objectives of the ICDS programme are as follows :
*
*
*
*
*
To improve the nutritional and health status of children below six years of
age
To lay the foundation for proper psychological, physical and social
development of the child
To reduce the incidence of mortality, morbidity, malnutrition and school
dropouts
To achieve effective coordination of policy and implementation among
various departments to promote child development
To enhance the capability of the mother to look after the normal health and
nutritional needs of child through proper health and nutrition education
In addition to children below six years of age, ICDS takes care of the essential
needs of the pregnant women and nursing mothers residing in socially and
economically backward villages and urban slums.
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ICDS, which has been in operation for more than two decades, is striving to
adueve the aforesaid objectives, with a package of services which include^ ■
• Health
- Immunisation
- Health checkups
- Referral services
- Treatment of minor ailments
• Nutrition
- Supplementary feeding
- Growth monitoring and promotion
- Nutrition and health education (NHED)
• Early childhood care and pre school education to children of 3-6 years
• Convergence of other Supportive Services
Each of die above is described briefly below:
Immunisation
Immunisation of infants / children against six vaccine preventable diseases, viz.,
tuberculosis, poliomyelitis, diphtheria, pertusis, tetanus and measles protects them
from these six killer diseases which are major preventable causes of child
mortality, disability, morbidity and related malnutrition.
Immunisation of pregnant women against tetanus helps in reducing maternal and
neo natal mortality.
Immunisation of infants and expectant mothers is provided by die health
functionaries at PHC and Subcentre in accordance with the national immunisation
schedule.
The Anganwadi worker assists the health functionaries in :
- Coverage of the target population for immunisation
- Organisation of fixed day immunisation sessions
- Maintenance of immunisation records and follow up to ensure full
coverage
4
Health Checkups
The service of health checkups includes :
- health care of children below 6 year's
- antenatal care of expectant mothers
- post natal care of nursing mothers
At the AWC, children, adolescent girls, pregnant women and nursing mothers are
examined at regular intervals by the MO, LHV and ANM.
The AWWs provide a link between the village and the sub centre or PHC. The
service of health checkups is aimed at reducing complications during pregnancy
and reducing prenatal mortality.
Referral Services
Referral services are provided by the AWW to tiie children and mothers who need
prompt medical attention. The AWW has been oriented to identify the children and
mothers needing referral service and refers them to the referral centre / hospital or
Supplementary Feeding
Supplementary feeding is provided to children below 6 years of age, pregnant
women, nursing mothers and adolescent girls from low income families in the
AWc area identified through a house to house survey.
By providing
supplementary feeding for 300 days in a year, ICDS tries to budge the gap
between national recommended intake and actual intake of children and women
from poor and disadvantaged communities.
The supplementary feeding programme of ICDS ai
arms at supplementing the family
food only and not at substituting for family food.
Supplementary food is provided to pregnant women and nursing mothers (upto six
months ot nursing) to help in meeting the enhanced requirements during the period
ot pregnancy / lactation.
5
Growth Monitoring and Promotion
Growth monitoring and nutrition surveillance arc the important activities of the
AWW which are crucial for assessing the impact of the health and nutrition related
services.
/..he AWC, children below 3 years of age are weighed every month and children
of 3-6 years are weighed every three months. Tire AW maintains weight for age
growth charts tor all the children below 6 years. These growth charts help in
detecting growth faltering and assessing their nutritional status.
The AWW identifies the severely malnourished children fin Grade III and IV') and
provides special supplementary food which may be therapeutic in nature or double
ration and refers them to health centre or hospital.
Nutrition and Health Education
Nutrition and Health Education (NHED), a key activity of the AWW, is aimed at
capacity building of women so as to enable them to look after their own health and
nutrition needs as well as that of their children and families.
Under NHED, basic health and nuinhon messages related to child care, infant
feeding practices, utilisation of health sen-ices, family planning and environmental
sanitation are given to the women through group sessions, house visits and
demonstrations.
6
Pre School Education
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Early childhood care and pre school education, provided under the ICDS, focuses
on the total development of the children. The Preschool education programme is
directed towards providing and ensuring a natural, joyful and stimulating
environment with emphasis on necessary' inputs for optimal growth and
development of the child.
The preschool education programme, conducted through the medium of play, aims
at providing a learning environment for the promotion of social, emotional,
cognitive, physical and aesthetic development of the child. The ECCE component
of ICDS also contributes to the universalisation of primary education, by providing
to the child the necessary preparation for primary schooling and offering substitute
care to the younger siblings, there by freeing the older ones (especially girls) to
attend school.
Convergence of Services
ICDS provides convergence of olher supportive services such as safe drinking
water, environmental sanitation, women's empowerment programmes, non formal
education, and tuiuft literacy.
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INNOVATIVE REFRESHER TRAINING
Refresher Training of Anganwadi Workers (AWWs) is aimed at keeping the skills
upgraded besides orienting diem towards die latest developments in the field. Till
1982, there was no provision for organising refresher training programme for
AWWs. In 1983, the first ever one day special reorientation programme for
AWWs who had worked for at least two years in the ICDS was organised.
Refresher Course in Preschool education for the AWWs across the country
followed this.
In 1986, a 14 day (Il working days) Refresher Course for AWWs who had
worked for at least 2 years after receiving Hie initial training was introduced
Subsequently, the duration of this training was enhanced to 18 days (14 working
days).
Review ot the training status of the AWWs across the state of Karnataka indicated
a heavy backlog of AWWs to be covered for training and inability of the
Anganwadi Training Centre (AWTC) to undertake the retraining of these AWWs
due to their pre occupation with the task of organising job training of workers.
In the light of the above, the Government of Karnataka proposed an innovative
refresher training programme, wherein all the AWWs of the state would receive
refresher training within a period of 2-3 years in their own district, by the District
level core training teams in a decentralised manner
The innovative refresher training programme is aimed at enabling AWWs to
respond to the emerging programme thrusts so as to achieve the stated goals for
improved child nutrition and health status.
For imparting the training, district level core teams, consisting of ICDS field
personnel (with their rich field experience), were constituted instead of the
conventional trainers
8
Main features of the innovative refresher training programme are as follows :
*
Against the conventional refresher training syllabus covered in 18 days, a
condensed course is followed for a duration of 6 days. The curriculum,
based on die needs of the grass root level workers was evolved through
consultations and workshops with the active participation of the field level
staff academic institutions, training institutions etc.
*
Die training was imparted by a group of field level staff at various levels
from ICDS as well as health department.
In each district, a group of five trainers, consisting of Assistant Director.
CDPO and Supervisor from ICDS and Medical Officer from Health and one
instructor from AWTC was raised. All the core group members were
trained by N1PCCD for one week with the focus on orientation to die
curriculum and methods of training.
*
The refresher training was imparted at district level.
*
The curriculum, developed in consultation with the ICDS functionaries,
including AWWs, concentrates on the field operations and areas where
AWWs need special inputs.
*
In order to supplement for the training, training material have been
translated to Kannada and the same was distributed among the trainers as
well as trained AWWs.
The innovative refresher training programme was implemented in two phases. In
the first pnasc, the training programme was implemented, on an experimental
basis, in 4 districts, viz., Bellary, Gulbarga, Dakshina Kannada and Shimoga. In
the second phase, the training programme was implemented in rest of the districts
of the state, on the basis of the positive feedback provided by the NIPCCD’s
evaluation study.
Tire refresher training programme, designed by die Department of Women and
Child Development with NIPCCD’s cooperation and UNICEF’s assistance had
covered 26,500 of the 39,985 AWWs of the state (during 1994-1997).
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CHAPTER 2
OBJECTIVES
MSM
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2.1
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OBJECTBTS
■ >
A need to conduct a study to assess the impact of the ICDS Programme with
specific reference to the innovative refresher training imparted to the AWWs
during 1994-1997, was felt by the DWCD and UNICEF.
Hence, the present study was undertaken by MODE with the following specific
objectives;
*
To assess the impact on health and nutrition status of children (below 6
years of age)
*
To assess the impact of early childhood (preschool) education on primary
school enrollment
*
To find out the impact on women’s knowledge and awareness of health and
child care practices
*
To assess the impact on coordination and convergence of services
*
To assess the impact on community participation
*
To suggest corrective actions.
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CHAPTER 3
METHODOLOGY
12
3.1
SAMPLING DESIGN
In order to get an unbiased assessment of the situation, selection of the
respondents - functionaries and beneficiaries - was done using a multi stage
stratified random sampling design which is explained below:
Selection of Blocks
Firstly, the total number of ICDS blocks or projects were divided in to six zones,
viz.. North, South, Central, Coastal, Tribal and Urban, on the basis of geoethnic
charactenslics like location within the state, extent of tribal population etc.
80 projects were selected across the six zones. Number of projects selected in
each zone was in proportion to the total number of projects in the zone. The list of
the 80 projects/blocks selected in consultation with UNICEF and Department of
Women and Child Development, is given in Appendix.
Selection of AWW/AWC
Total coverage of AWWs was 2650 which is 10 per cent of 26,500 the total
number of AWWs trained (as specified in the TOR). This sample was equally
divided amongst the 80 chosen projects.
The selection of AWWs within each project/block was done by systematic random
sampling using distance from the project headquarters as the criteria. That is,-all
the centres in the project were arranged in ascending order on the basis of distance
from the project headquarters and then the required number of AWCs were
selected by systematic random sampling technique. This includes AWWs who
received the innovative refresher training as well as those who could not receive
fre innovative refresher training.
Selection of Functionaries
All the CDPOs of the selected projects got self selected for the interviews. From
each project, 2 supervisors were selected and interviews. District. level officials
like Assistant Director, Programme Officer available in the districts visited were
covered for cjualifative in depth interviews.
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Selection of Beneficiaries
-f
Quantitative survey among mothers was carried out ip 160 villages - 2 per project.
And in each village, 10 mothers with a child below 6 years of age were selected
using the list of such mothers generated from the Family Survey Register
maintained by the AWW as the sampling frame. The selection was done with
systematic random sampling technique.
Selection of Community Leaders
From each project, two community leaders were selected for tlw qualitative
in-depth interview. The sample consisted males as well as females.
3,2
COVERAGE
Table 3.2a gives the number of functionaries and beneficiaries covered in the study
by research technique
Table 3.2a Coverage
r
Research
_______ Technique_____ j Target
Structured interview
2650
Part observation (7days)
5
Scanning of records
2650
Structured interview
160
In depth interview
80
In depth interview
! In depth interview
(
! In depth interview
In depth interview
In depth interview
In depth interview
Respondent
AWW
AWW
AWC
Supervisor
CDPO
POV
AD+
CEO*
AWTC+
ANMTJTV^
MO*
Community
Leader
In depth interview
ZP/TP President* i In depth interview
Mothers
\ Structured interview
160
j 1600 ;
Achieved
2665
5,
2665
144
74
7
18
8
18
25
5
Reason for
shortfall
Vacancy
Vacancy
160
12
1606
Additional coverage, not envisaged in the proposal. Added as suggested by the
department.
14
3.3
RESEARCH METHODS
■i
The research techniques used in the study include structured interviews, in depth
interviews and participant observation.
Structured interview's are one to one interview's carried out with the help of a
structured questionnaire, with possible codes provided and a few open ended
questions.
In-depth mtennews are one to one free flowing interview's earned out with the help
of a guide which lists out the various issues to be covered in the interview.
Participant observation involves recording through observation while the
functionaries are performing different activities like in centre activities, house
visits, NEED sessions, meetings etc. One investigator was attached to one
Anganw'adi Centre for a period of 10 working days from morning to evening.
The various research instruments used in the present study are bsted below :
1.
2.
3.
4.
5.
6.
7.
8.
9
10.
AWW Questionnaire
Supervisor Questionnaire
CDPO Questionniure
Parents Questionnaire
In depth guide - Community Leader
In depth guide - Asst. Director/PO #
In depth guide - ANM/LHV/MO*
In depth guide - AWTC Functionaries*
In depth guide - Zilla / Taluk Panchayat President *
Observation recording sheet - AW1'
* All these instruments were in addition to those envisaged in our proposal.
Added as suggested by the Department
Drafts of all the research instruments were submitted to UNICEF and the
Directorate of Women and Child Development department. The instruments were
finalised alter incorporating all the changes based on the discussions with
UNICE'F/Department and pretesting in the field.
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3.4
/
ITEM) OPERATIONS
Five teams., consisting ot 6 field investigators and I supervisor each, were raised.
Intensive training was imparted to these teams at MODE’S Bangalore office
during December 5-15 1997. During the training, class room instructions, field
visits, interviewing and scrutiny were organised so as to make the investigators
totally efficient in die data collection process. All efforts were made to maintain
uniformity in imparting training by using the Kannada version of the questionnaires
and field manual with clarifications for the questionnaires. This helped in
controlling non sampling errors.
Actual field work was started on December 23, 1997 and went on till February 6,
1998. Tlie field work was delayed due to legislative council elections and strike by
the state government employees.
.MI the interviews were administered in Kannada, the mother tongue of the
respondents.
Senior research and field professionals from MODE made field visits at regular
intervals during the field work Purpose of the field visits was to make on the spot
assessment of the ground realities and monitor the quality of data besides giving
clarifications needed at the field level. They also interacted with the functionaries
at various levels as well as beneficiaries.
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3.5
DATA ANALYSIS
■i
Toe qualitative in depth interviews were analysed by the process of content
analysis. In addition, frequency tabulation was carried out for some key measures,
to get a gross level perspective.
The quantitative questionnaires were computer analysed. All the questionnaires
were scrutinised, translated and coded (in case of open ended Questions), given for
data entry with MODE’S regular vendor and processed on MODE’S in house
pentium machines.
The analysis was earned out through tailor made software developed by MODE’S
software specialist.
Analysis of the data from AWWs and Parents interviews was carried out by the
training status of the AWW. ’these results will be presented in the report for the
AWWs who received training and. who could not receive the training so ns to
capture the differences in die performances of trained and untrained AWWs.
The results are presented in the form of frequency' distributions and cross
tabulations. Wherever possible, Statistical tests of significance (eg. Z test, for
large sample) are applied so as to test the significance of tire difference observed
between different values. Z value of 1.96 or more indicates that the difference
observed is statistically significant at 5% level of significance and the difference
can be considered as insignificant if the z value is less than 1.96.
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17
wen
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CHAPTER 4
ANGANWADI WORKER
1
11
IS
4.1
PROFILE
Anganwadi is the focal point for delivering the package of services envisaged in
the 1CDS Project An anganwadi centre (AWQ is set up, on an average, for a
population of 700 in tribal areas and for a population of 1000 in rural and urban
areas A local female Anganwadi Worker (AWW) runs the AWC with the help of
a local helper.
Profile of the AWWs in terms of key socio economic characteristics is presented in
Table 4.1a
Table 4. la indicates that about, half of the AWWs are from other or forward castes
while about one fifth belong to SC/ST groups. Four out of five AWWs have
completed 1 Olli standard and this is a good sign which indicates that the criterion
regarding educational qualification was being met at the time of recruitment in
most of the cases
The age distribution of the AWWs represents a middle age structure among the
AWWs. Mean age of the AWWs was observed to be 31 years.
Majoiity of the AWWs (69%) were currently married and about one fourth were
never married at the time of the survey Proportion of widows/divorcees was
small.
Two out of eveiy three AWWs reported to be staying in the AWC village. That is,
one third of the AWWs stay tn a nearby village. They travel an average distance of
5 kms (one way) in a day to reach the AW centre.
The recruitment policy which emphasises selection of local candidates seems to be
not being adhered to at the time of recruitment as about one third of the AWWs
reported to be not staying in the AWC village.
According to the Senior District Level Officials, the recruitment of AWWs is done
by a committee consisting of officials like DS (Chairman), CDPO (Secretary), AD
(member) and 3 non
(Taluk Panchayai
non officials
officials (Taluk
Panchayai President
President and
and 22 local
local
repressnranvesj.
ii
19
M«»fc
The recruitment policy specifies the following entena for selecting AWWs :
~ Should be ol 21-45 years of age
Should be selected from within the viilage/local community (to be supported by
nativity certificate, ration card, voters list, etc.)
- Should be acceptable to the local community
Should be able to work with women and children from SCs, STs and other
weaker sections of the community
- Should have completed Sth standard
TOe officials ares by and large, satisfied with the recruitment policy But some of
them were concerned about the political interference in the selection process. And
they suggested that the candidate who is interested to work, dedicated and needy
(say widow, divorcee etc ) he given preference. In spite of the selection criterion
regarding local residence of the candidate, more often we find many AWWs who
do not belong to the AWC village. The officials attribute this to the interference of
the local pohticrans who msisl that the candidate suggested by them should be
selected irrespective of the residential status of the candidate. This brings out the
necessity tor making the recruitment policy free from political interference.
25
Table 4.1 a Background Cbaracteristics of AW^Ws
r
I
Caste
SC
ST
BC
OC
>■
i
I
<
Education
Upto 7 th
Sth-9th
1 Oth & above
%AWWs
16
7
28
49
2
20
78
(.Yrs)
<30
30-49
50+
Ml AN
SI)
48
50
2
f
31.4
7.1
MarUal.SWs
Unmarried
Married
Widow / Divorcee / Separated
26
69
5
Residence
AWC Village
68
Total No, of AWWs
2665
Distance from residence to AWC (Kms)
MEAN
SD
5.2
5.0
Total No. of AWWs not staying in AWC i
I village
!
793
■?
’
-i
Fig.4.1 Caste Distribution of AWWs
□G
28 >
’SC f 3'i
M
O
J
I
\
■
f
0C
49
Fig 4.2 EDUCATION STATUS OF AWWs
I
i
C■
/
/
X:
I •
I- ■ :
•
i
I
8th - 9th
k. 20
Upto 7th
■■■1
lb
S’ •
\ •: •:
1Oth* \
78
: : 7
7 ■ !
:■ 7
\/
/
i
2
O
cr
(i
2,-?Pc
I1
I
!♦*'
!
it •
J
I
i
it 4
ft4
+
o
ID
LU
I
I
(t«'
?
I
I
—*
I
o
«»•
(
I
I
!
i
i
I
I
I
i
«*
Oj
I
I
I
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co
{
i
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§5
I
I
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MJB
Q
LU
I
i
/
I
IT
I
u
i
V
V
T
it
it
I
I
00
I
(••ttttttttttttttttttttttttttttttttttttttttttttttttttil
/
i>Htt:mttt**tittt’^tt>tttttt^:t^:tt:::::::::::u
!
!........................................................................................... \
o
co
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tttttttt»ttttttttttttttt*ttttttttt»ttt*tt,ttttttttttt1l
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.[
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CD
‘•'•♦••’♦•'•’'••♦♦***tttttttttttttt»ttttt»ttttttttttitt«*
♦ ttttttttttttt.tttttttttt.tttw.ttii
II
1
I
A
X
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<
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<N
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;
9“
f
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I
u
21
4.2
JOB PERFORMANCE
■1
AH the AWWs were asked about the different activities they are supposed to carrv
out as AWW. Analysis of the spontaneous responses of the AWA’s is presented in
Table 4.2a
Pre school was mentioned by almost ah the AWWs while house visits, meetings,
immunisation and supplementary feeding were mentioned by more than 70 per
cent of the A WWs. These are the services on top of the mind of the A WAVs Of
the remaining services, Nutrition and Health Education, recording work and
weighing ol children were mentioned by about 40 to 50 per cent of the AWWs
Rest oi die sei vices were mentioned by a small proportion of the AWWs. As the
data presented pertains to the spontaneous response of the AWWs, it can not be
concluded that rest of die services are not being carried out by the AWWs.
Table 4.2a AcJiYiti^up^^o_^ca^edout
(.S tat?d response of AWWs)
(%AWWs)
Activities
__
Pre school
House visits
Meetings
Immumsation
Supplementary feeding
NHED
Recording work
Weighing of children
Ante natal services
Identifying referral cases
Plotting of weights
Referral follow up
Community mobilisation
Mahiia Mandal
zz
Trained
98
86
77
74
70
I
!
t
45
43
37
21
16
11
10
8
Total No, of A WWs
1485
Spontaneous response
Note: Total e xcceds 100 due to multiple response
Untrained
98
86
71
73
69
48
45
41
35
18
12
11
9
7
1180
u
M9M
21
■w.
f
Jo sum up
MWs come from all caste groups with majority belonging to the other castes
Majority of them studted at least upto IOth standard, middle aged, currently
marr ied and stay in A WC village. In spite of the stipulation that the AWW should
be a local womwi, nor >klJ A WWs stay in the AWC vilk^e.
*
w
23
MOM
■ >
CHAPTER 5
HEALTH AND NUTRITION STATUS OF CHILDREN BELOW 6 YRS
I
u
24
M«M
lhe refresher training provided to the AWWs is expected to improve the health and
nutrition status ol the children ol 0-6 years of age. Attempts were made in the present
study to assess the health and nutrition status of the children from the villages with
trained AWW and untrained AWW. These results arc discussed in this chapter.
5.1
IMMUNISATION
AWW’s Respome
Provision of immunisation to the child so as to protect him/her from the six killer
diseases - TB, Polio, Diphtheria, Pertusis, Whooping cough and Measles - is a
function of the AWWs. Immunisation service is provided by the AWWs with the
help of the health functionaries like ANM.
Almost all the AWWs reported provision of immunisation as a job function.
However, 8 to 9 per cent of the AWWs reported that they are not able to provide
immunisation to all the children in the target group (Table 5.1 a). This was mainly
attributed by the AWWs to lack of cooperation from tire mothers.
All the AWWs were ttsketi tibout the immunisation coverage figures (when it was
last organised). The AWW's response was venned with die entries in the relevant
registers / records. The results are presented in Table 5.1 a In six AW centres - 3
with trained AWW and 3 with untrained AWW - less than half of the children
were immunised. Further probing about the reasons for not being able to cover all
the children for immunisation, revealed that non availability of the mother,
sickness of the child and lack of coopcrarion from the mothers were the major
constraints.
More than half of the A WAVs reported the coverage of immunisation as 100 per
cent. Proportion of such AWWs was higher among the trained AWWs, compared
to their counterparts who could not receive the refresher training. The difference
between the (f tuned and untrained AWWs was found to be statistically significant.
I bus iinmiuusution coverage figures were significantly higher in the centres with
trained AWWs indicating their better performance,
Only 60-6? per cent ol the AWWs reported the immunisation coverage to be
above l)() per cent. In the remaining centres, not ail the children could receive the
immuniHntion vnecinu thvy had to raceivo
H
25
Ensuring that all the children receive full schedule of the immunisation is an action
area because of the gaps in proportioB of children immunised.
About two third of die AWWs reported that all the children of 0-5 years received
the pulse polio drops on December 7, 1997. In all the centres, at least half of the
childtcn received the pulse polio drops. Pulse Polio coverage was significantly
higher in the centres with trained
AWs compared to those with
untrained AWWs. (Table 5 la).
Table 5. la Immunisation Coverage
(% AWWs)
Trained
Untrained
Yes
No
92
8
91
9
Total No. oi AWWs reported Immunisation as
activity
1101
863
1
2
16
16
3
62
1
2
20 (z = 5.18)*
17
<
3
57(z = 5.05)*
1392
1079
2
7
23
67
1
3
8
22
! 65 (z = 2.18)*
2
1485
1180
Wh.eth\'r_QbJv Io do
ElQPiLrtLOAPljdliLdrjmj,nin^^
< 25%
25 - 49%
50 - 74%
75 - 89%
90 - 99%
100%
month)
I
Total No. of AWs organised immunisation
Proportion of children given Pulse Polio
(DEC ‘97)
50 - 74%
75 - 89%
90 - 99%
100%
No response
Total No. of AWs
Significant at 5% level of significance.
I
f
I
F:ig.5.1 Immunisation Coverage
70
62
60
57 +
I
I
%
A
W
W
&
50
j
I
40 P
30
t-
20
16
2(T
19
20
(Jl
to
10 3
3
0
------- ___________
<50%
50-74%
75-79%
Proportion of Children Immunised
f—] Trained
Lsd Untrained
+ Significant at 5% level of significance
100%
r-----
Fig.5.2 Pulse Polio Coverage
I
I
I
I
80
70 -
67
65-t
60 %
i
50 r
A
W
W
s
I
40
i
30 r
23
cr
20
10
7
2
^3
—
j
_
i
____
0
50-74%
zi
8
75-84%
90-99i%
Prportion of children covered
EZJ Trained
I
Siginificant at 5% level significance
I—
1
3 Untrained
100%
N
16
IHV0E
- - V!
S^Z
REFERRAL SERVICES
Angnnwadi worker (AWW) is expected to identify the malnourished and sick
children needing referral .service and refer them to the nearest health centre /
hospital. Provision of referral services is another important service provided under
AH the AWWs were asked a few questions to assess the extent of referrals and
understand the kind of cases referred by them. Results are presented in Table
5.2a
About one ihud of the .AWWs did not refer any child during the 3 months period
preceding (he survey
On an average, 3.5 and 29 children were referred by the trained and undained
AWWh respectively dunnp the 3 months period before the survey. Performance ol
tlic triuned AWWs regarding the referral services seems to be significantly better
compared to those who could not receive the training. The trained and untrained
AWWs could not refer, on an average, 1.6 and 2.3 potential cases respectively
(during the 3 months period before the survey). This indicates that the needy
people arc by and large referred to the referral centres by the AWWs. But the
referral service is being effectively provided by the AWAVs who received the
innovative refresher training
On being further probed about the reasons for not being able to refer these
potential cases, the AWs mentioned about the constraints listed below :
- financial problems of parents
- lack of knowledge among parents (about referral service)
- less importance given by parents
Senior functionaries also reported about the aforesaid problems.
The suggestions given by the functionaries include provision of funds (towards TA
for patient as wed as parents) and special treatment/recognition to the patients
referred by the AWW. Availability of the Medical Officer (Doctor) at the referral
centre and proper attention paid by him/her will also have positive influence on the
utilisation <)l referral services.
M«M
27
1 able 5.2a Mo. of children referred
(% AWWs)
Trained AWW
Nunibgl_gf children referred (last 3
JTLQIltbsj
None
I- 5
6-10
II +
Untrained AWW
33
56
8
3
37
55
7
1
Mean
3.5
2.9 (z = 8.63)*
Total No. of AWWs
1485
1180
Cases referred
Malnutrition
ARI
Difirrohca
35
22
43
36
25
39
Total No. ot AWWs reteired children
991
744
No of cases could not refer
Mean
SD
ul AWWs_who could not refer
* Significant at 5% level of significance
1.6
1.4
61
2.3 (z = 2.03)*
i
I
2.1
51
u
2S
53
NUTRITION STATUS OF CHILDREN
.i
Reduction in tfre levels of malnutrition is one of the key- objectives of the ICDS
programme. To find out the malnutrition levels among the children, the relevant
information was collected from all the AWCs through scanning of records.
Analysis of this data is presented in Table 5.3a.
Analysis presented in Table 5.3a reveals that about 5 to 8 per cent of the children
were malnourished and more than one third of the children across the various age
groups were in normal grade of nutrition. About one fifth of the children below 6
years of age were in Grade II. These children need special attention towards
regular growth monitoring and supplementary feeding to enable them to move to
Grade I rather than to Grade HI.
levels of inidimfntion were on lower side across the different age groups but were
slightly higher in the centres with untrained AWWs. Centres with trained AWWs
had significantly higher proportion of infants in normal grade while the centres
with untrained AWWs had significantly higher proportion of Grade IV infants.
The kind of inputs given by the trained AWW as a result of the training she
received may be responsible for the difference observed between the trained and
untrained AWWs on the above aspects.
Belter nulrilion practices, reduction in incidence of malnutrition among children
and improvement in nutrition status of tlw children due to the care provided by the
AWW were cited as the changes that have taken place in the villages due to ICDS
programme oy community leaders and Zilla / Taluk Panchayat leaders.
We can conclude that ICDS has helped in reducing malnutrition and improving the
nutrition status of the children. And ICDS has played a vital role in bringing the
transition from higher levels of malnutrition to lower levels of malnutrition
u
west
29
TftbJe 5-3a Distribution of children by Age and Nutrition Grade
(As per records)
f
Trained
[% children)
Untrained
Age / Nutrition Grade
< 1 year
Normal
Grade I
Grade II
Grade III
Grade IV
47
33
15
0
5
44 (z-7.77)*
33
16
1
7 (z= 10.80)*
Total No. of children < 1 year
9667
6900
33
41
21
I
4
33
39
19
1
7
lotiil Nu oI children U years
33877
24580
3ziLysay±
NonniJ
Grade 1
Grade II
Grade III
Grade IV
35
41
20
I
4
37
36
19
I
6
Total No of children 3-6 years
44311
32276
AU
Normal
Grade I
Grade II
Grade HI
Grade IV
36
40
20
1
4
37
37
19
1-3 yettrii
Normal
Grade 1
Grade II
Grade III
Grade IV
I i Gia! No, of children 0-6 years
Signifleanr ar 5% level of significance
I
)
I
!
i
mo cc
o I o„’j
1}
7} (z= 48.22)*
v.i /
I
Fig.5.3 Nutriton Status of Infants
%
i
I
60
50
i
I
^47
!
I
n
f
a
n
t
s
40
I
33
33
30
k)
20
15
10 -
0
£»
16
...... 8*
J__
— —* - ——><d----
Normal
Gr I
Gr II
Grade
L-._] Trained
+ Significant at 6% level of significance
Untrained
Gr III & IV
Fig.5.4 Nutriton Status of
Children (0-6 years)
■
i
Children (0-6 yrs)
50 %-------------------------------------
i
i
i
4
36
I
i
i
I
3QK
37
40
----- 1 37
f
I
!
i
i
20
20
IS
<1
CT
10
■
5
0 L-Normal
Gr I
Gr II
e:
Q‘
■L
Gr III & IV
Grade
i—] Trained
IsSd Untrained
i
i+ Significant at 5% level of significance
I
i
iI
3€
S.4
M«K
GROW I II MONITORING
Monthly weighing of all the children below 6 years of age and plotting of weights
on the growth chart are important activities performed by the AWWs, This
provides the base for assessing the nutation status of the children and identifying
the malnourished children.
All the AWWs interviewed in the study were asked about foe different aspects
relating to growth monitoring like ability to do, date of last weighing, and
proportion of children weighed. Analysis of this data is presented in Table 5.4a,
About three fouifo of the AWWs who reported periodic weighing of the children
as an activity earned out by them, reported that they were able to weigh foe
children regularly. Rest of foe AWWs - 22% trained and 27% untrained - were
not able to weigh foe children regularly mainly due to lack of cooperation from foe
parents/mofoers (mentioned by 96 AWWs) and non availability of the weighing
scales (mentioned by 87 AWWs). Some of the AWWs reported font they borrow
foe weighing .scales from foe near by AWC everytime they cany out weighing.
Hence there is an urgent need to supply weighing scales to these AWCs.
Plotting of the weights is not a problem area because almost all foe AWWs who
reported it as an activity to be canted out by them were able to do it.
Ii
31
7
More than half of the AWWs reported to have weighed die children less than one
month before foe survey. Last weighing took place more than 3 months before foe
survey in 15 to 21 per cent of foe AWCs. Proportion of AWWs carrying out
weighing of children regularly was significantly higher among foe trained AWWs,
compared to foe untrained AWWs. Regular weighing of children was more
commonly observed among foe trained AWWs and it appears to be a problem in
case of foe untrained AWWs. Perhaps better convincing capability, interaction
skill and enlianced interest could be foe plausible reasons for better performance of
trained AWWs regarding the service of weighing of children.
In an identical proportion of 64 per cent of foe AWCs, more than 90 per cent of
foe children were weighed (last time). Less than half of foe children were weighed
in 3 to 6 per cent of the AWCs. The emerging issue is foal there is a need to
sensitise foe mothers regarding regular weighing of foe children and its
importance.
Further classification of the frequency of weighing data by age of foe child
revealed font die problem of irregular weighing was more common among foe
children below 3 years of age. Weighing of the pre school children (3-6 years)
was done more regularly by foe AWWs as they were readily available at the AW
centre.
work and she may not
resolved. If the AWr stays in the AWC village, she can perhaps cany out the
weighing at any time which suits the mothers. The problem becomes more acute
if the AWA stays in a near by village and can not have flexible timings for
westing of the children to suit the mothers schedule.
u
32
Table 5.4a Grouch Monitoring
■ /
(% AWWs)
Able to Weigh the children
Trained
78
Untrained ~
73 (z - 2.57)*
Total No. of AWWs reporting weighing as an
activity
644
553
Able to plot the weights
98
97
Total No. of AWs reporting plotting of
weights as an activity
231
258
When last weighed children
< I month
1-2 months
2 - 3 months
3+ months
62
20
3
15
58 (z-3.97)*
19
2
21 (z - 7.65)*
3
II
21
27
37
6
12
19
22 (z 5.61 )*
42
Pioportipn 9/ vhUtk^H. weighecLijastJimk
26 - 50%
50 - 74%
75 - 89%
90 ■ 99? ;,
100%
7otal No. of AWWs (registers made available)
* Significant at 5% level of significance
(
1349
f
1007
Fig.5.5 Last Weighing of
Children (0~6 years)
1-2 months
k back
4
< 1 mon th
l?a ok
' 1 month
back
62-f
s—* r—
months
back
19
3+ months
back
15-k
f
59 4
-3 months
back
3
M
months
back
X^;:
2V
months
back
.^1
Trained
f
Significant at 5% level of significance
Untrained
11
33
To sunt up
lhe immunisation programme seems to be effective across foe AW centres
because of the higher levels of coverage. Significant differences were noticed
between the trained and untrained AWWs in terms of coverage for immunisation
(say Measles, Vitamin A, Pulse Polio).
AWWs who received innovative refresher training could perform better m
providing referral services to the needy children and mothers.
Nutniion status ol die children was found to be satisfactory across the centres
visited due to the fact that only 5 to 8 per cent of the children below 6 years of age
were malnourished Incidence of malnutrition was found to be less in centres with
trained AWWs.
The trained A\VV<rg were able to deliver the service of growth monitoring and
promotion more efficiently They were able to communicate to the mother aboul
the kind id i an- io be takim in case the child is malnourished.
Aforesaid factors perhapa led to improvement in the health and nutrition status of
the children below 6 years of age.
On being asked about the post ICDS changes that have taken place in the village,,
the AWWs mentioned about the following changes :
- enhanced trust in immunisation
- improvement in health and nutrition status of the children
Mothers interviewed in the study highlighted the achievements of the ICDS which
are listed below:
- immunisation tor ail the children
- improvement in health status of the children
- reduction in mainounshment among the children
u
34
CHAPTER 6
PRE SCHOOL EDUCATION
M«»b
H
35
In this chapter, performance of the AWWs - trained Vs untrained - in terms of Pre
•school education sessions is discussed on the basis of .scanning of records and response
from AWWs as well as mothers. Pre school or early childhood education is another
important service provided by the AWW for children of 3-6 years of age. Purpose of this
service is social, mental and psychological development of the child. This service is
more often noticed to have a positive impact on the child’s schooling status also.
6.1
ACTUAL PERFORMANCE (SCANNING OF RECORDS)
The AWWs are supposed to organise the pre school sessions for about 25 to 26
days tn a month for all the < hildren of 3-6 years of age. To get a feel of the real
situation, informithon relating to number of days pre school session was held
during the 1 month period bef ore the survey, proportion of children attended and
the day when the last session was held were collected during the study by scanning
die relevant records The analysis presenter! in Table 6. la reveals that about four
out of five AWWs conducted tire pre school sessions for 25 or 26 days during the
one month preceding the. survey. Proportion of AWWs who conducted pre school
■u-ssinns for ?Si (|ftyj. w,ks sh^bUy but significantly higher among the trained
AWWs (H5% Vs Xl%, z-8 41)
Proportion of AWWs who did not organise pre school session during 1 to 6 days
before the date of the survey varied from 13 among the trained AWWs to 19
among the untrained AWWs Here again,, tire difference was found to be
statistically significant at 5% level of significance.
fhe trained AWWs were more interested to perform their duties as AWW and
they were also better equipped to make the pre school sessions interesting because
of the enhanced communication ability and better understanding about the
effective use of the pre school aids.
As regards the pre school attendance., about half of the AW centres recorded more
than 90% attendance during the 1 week preceding the survey. The problem seems
to be more acute in 14 per cent of the AWCs where the attendance varied from 50
to 74 per cent.
Discussion on the factors responsible for low pre school
attendance is given in the next section.
u
M«9E
■i
Table 6.1 a No. of days Pre school held and attendance
(% AWWs)
Trained
ISfl-PLdaysJieJdd^Iiist month)
10-20 days
21-24 days
25-26 days
When last held
1 - 3 days before
4 - 6 days before
/ I (J days Ijcfbie
11 - 14 days befoic
15 > days Ixjfore
Total No. of AWWs
PtQPj3ition_attended (Last week’s average)
25 - 29 %
~
'
50 - 74%
75 - 89%
90 - 99%
100%_________
* Significant at 5% level of significance
17
83
1
(
82
5
Untrained
I
18
81 (z- 8.41)*
76 (z- 23 89)*
5
5}
1
2
10
2} (z »> 26.61)'*
12}
1449
1148
I
14
37
1
II
35
28
20
30
20
Fig.6.1 No. of Days Pre School Held
I
I
I
I
25 - 26 days
8-3 +
1
1-24 da vs
17
4 days
19
u
26 days
81 +
Trained
^Significant at 5% level of significance
Ch
Untrained
H
37
l2
PRESCHOOL SESSIONS - AVVW’s STATED RESPONSE
Attempts were made in the study to elicit information on preschool sessions like
different activities earned out, time spent, and use of aids, from tire AWWs
Results relating to these issues are presented in Table 6.2a.
About three fourth of the AWWs (71% untrained and 75% trained) reported that
they were able to conduct the pre school sessions properly and regularly. Rest of
the AWWs (25 to 29 per cent) were not able to organise the pre school sessions
regularly and properly mainly due to lack of cooperation from the mothers in
sending the child to AWC. Another problem faced by the AWWs was that the
children ot 5 years were attending the primary school so as to get the rice given
under the mid day meals scheme
.Senior ollictals inlet viewed in the study also opined that the attendance at the pic
school was n problem mainly because of the following reasons :
- children join the pninmy school at the age of 5 years so as to receive the
rice given under the mid day meals scheme,
- parents prefer to send the children to private nurseries.
- Language problem in border districts like Kolar, Bellary (Telugu, mother
tongue vs. Kannada, the language of instruction)
Proportion of AW's reporting their inability to conduct the pre school sessions
properly was slightly but significantly less among the untrained AWs, compared
to the trained AWWs (29% Vs 25%).
Special attention and efforts are needed to ensure that all die AWWs conduct pre
school sessions regularly and propcriy.
In this connection, the problems
mentioned above need to be resolved by the senior functionaries.
Almost all the AWs reported that they cany out activities like teaching games,
songs and telling stories during the pre school session. Teaching alphabets and
numbers W'ere mentioned by about half of the AWWs.
On an average. AWWs reported that they spend 165 to 167 minutes (about 2 hrs
45 mts) on pre school sessions everyday.
Of this, maximum time is usually
devoted for games (48 mts) followed by songs (33 mts), stones (32 nits),
alphabets (26 mis) and numbers (24 mtsj.
H
38
I able 6.2a Ibcsdiool Sessions - (AWW’s Response)
Abie to organise pre school sessions
lotal No of AWWs reporting pre school as an
activity
•/
Trained
75
__ UTitraincd __
71 (z-14.05)*
1452
1157
99
98
54
46
97
1485
99
98
53
46
95
1180
48.1
1471
33.1
1449
26.8
803
24.7
689
2.6
1434
165 (mts)
48 7
1170
33.6
1158
26.5
624
24.5
540
3.4
1124
167 (nits)
A^iyities-AwiiAidje^tf1
Teaching games
Teaching songs
Teaching alpliabets
Teaching numbers
Telling stories
Total No. of AWWs
Average time spent on (in Mts)
Games
Total No. of AWWs teaching games
Songs
Total No. of AWWs teaching songs
Alphabets
Total No. of AWWs teaching alphabets
Numbers
Total No. of AWWs teaching numbers
Stories
Total No. of AWWs telling stories
Tg^gL*!1?0 sPcnt (Mean)
Cl Total exceeds 100 due to multiple response
* Significant at 5% level of significance
I
I
Fig.6.2 Ability To Organise Pre School
I
»
»
Not ab!e
k 90
Not able
Z
k 25
I
I
I
I
I
1
Able
75+
u
03
to
2^^
Able
71+
Trained
Untrained
I
i
TSignificant at 5% level of significance
i
iI
39
6.3
M«»b
PRESCHOOL ATTENDANCE OF CHILD (MOTHER’S RESPONSE)
■ /
All the mothers were asked about awareness of the pre school sessions, attendance
of the child, number of days the sessions are held and duration of the session
Analysis of this data is presented in Table 6.3a.
More than four fifth (8g to 89 per cent) of the mothers (with a child below 6 years)
mentioned pre school sessions as a service provided by the AWW indicating
higher levels of spontaneous awareness about the pre school. As a matter of fact,
pre school emerged as the top most service provided under fire ICDS (by AWW)
in the minds of the mothers. Levels of aided awareness about pre school among
the mothers of 3-6 yrs child were also noticed to be very high. So, awareness of
pre school was almost universal and hence awareness is not a problem area.
Almost all (94-95%) the mothers reported that the child ever attended the pre
school at the AWC And 92 per cent of the mothers reported that the child was
(currently) attending the pre school sessions at the AW centre.
As regards lhe number ol days pre school sessions were held, about one fifth of
the mothers reported it to be 25 days (in a month). About two third of the mothers
reported that the sessions were held for 21 -24 days in a month.
According to the mothers, the sessions on an average, were held for 3 hrs 45 mtn.
40
Tjible 6.3u Preschool Awareness & Attendance (Mother’s Response)
(% Mothers)
_________ Centres with
Trained AWW Untrained AWW
Awnr^riesj,
Spontaneous
Total No. of Motliers with < 6 yrs child
89
940
668
Aided
92
91
Total No. of Mothers with 3-6 yrs child
441
281
Child ever attended
95
Child currently attending
92
Total No. of Mothers with 3-6 yrs child
405
94
92
255
88
AllnabwH f
No. of days sessions held (in a month)
Upto 15
5
16-20
6
21 -24
66
25
19
3
Can’t say
3
8
67
20
3
Duration of session
Upto 2 hrs
3.1 - 4 hrs
6
38
44
52
4.1-5 hrs
II
15
Mean (hrs)
3.42
3.46
Total U
No. of Mothers reporting preschool
. t ■J
I
attendance of child
385
240
2.1 -3 hrs
4
27
i
u
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♦ * ♦♦ ♦ < ♦ ♦ ♦ ♦*♦
Wj ♦ o iTr^
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<- i
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!
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LU
i
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__ ;__
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O
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40
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______ 2_
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41
■I
Hildings relating to the preschool sessions from die participant observation of 5
AWCs (3 wuh tnnncd AWWs iwid 2 with untrained AWWs) are as follow's :
4-
Pre school sessions were held for all the 7 days in 4 out of the 5 AWCs
observed.
*
In one centre (with untrained AWW), pre school was held for 5 out of the 7
days period of observation.
*
Average attendance in the centres with trained AWs varied from 51 per
cent to 98 per cent.
*
In case of centres with untrained AWWs, average attendance varied from 28
per cent to 84 per cent.
*
The trained AWWs conducted pre school sessions for about 50 to 120
minutes (on an average).
*
The untrained AWWs conducted pre school sessions for about 45 to 90
minutes (on an average).
*
The trained AWWs used pre school aids' for 4 days, 6 days and 7 days.
The untrained AWWs used pre school aids for 1 day and 3 days.
*
Flip books, charts/posters on animals were die aids used by' the AWWs.
*
The trained AWWs were noticed to be making aids locally (eg; picture card
of animal).
*
Use of integrated approach was noticed in all the centres (animals being tire
topic for tire week).
Above observations corroborate the findings presented in the earlier sections.
u
42
6.4
M«K
USE OF IN IEGRATED APPROACH
All the AWWs arc expected to conduct the pre school sessions using the integrated
approach under which 44 issues or subjects at the rate of one subject per one
weefc wdi be taken up by the AWWs For instance,, the issues taken up in the
month of October included Mahatma Gandhi (1st week) Birds (2nd week)
Hospital (3rd week) and Flowers (4th week). Besides the list of subjects to be
covered, detailed time tabic for every week was provided to the AWWs. The
integrated approach is aimed at improvement of views, development of absorbing
power, improvement of language and imagination, and social development.
On being asked whether they use the integrated approach, 90 per cent of die
trained AWWs and 80 per cent of the untrained AWWs replied in affirmative
Hie difference between the trained and untrained AWWs in terms of use of
integrated approach was found to be statisticallv significant at 5% level of
significance.
The refresher training imparted to the AWs, had a positive influence on the
extent of interest showed by the AWWs in various activities carried out by them.
And use of integrated approach was one among such activities receiving greater
attention from the trained AWWs
On being turther probed about the usea / advantages of the integrated approach,
the AWWs mentioned about the advantages listed below :
- Psychological development of die child
Better understanding as the same subject is taken up for 1 week
-. Better concentration of the child
- Child learns how to live because of the issues taken up
~ Better understanding as aids are used.
H
M«»fc
43
6.5
SCHOOLING STATUS OF CHILDREN
'1
Attempts were made in the present study to assess the impact of pre school
education on the child’s attendance in the primary school. To this end, nil (he
mothers were asked about the schooling status of the children of 6-14 yrs in the
house, lire analysis of this data presented in Table 6.5a, indicates the positive
influence of pre school on primary school attendance as only 8 to 9 per cent of the
households had children out of school. In 76 to 81 per cent of the households, all
the children of 6-14 yrs were in school at the time of the survev.
The impact seems to be more visible in the villages’ with trained AWWs compared
to the villages with untrained AWWs, with the difference being statistically
significant at 5% level of significance. This can be attributed to better
performance of the trained AWWs regarding the pre school activity.
On bang asked about the impact of the ICDS programme, AWWs mentioned
about the following changes relating to primary education in die village :
- child more interested to go to primary school (14 to 18%)
- increase in primary school attendance (17 to 20%)
- increase in primary school admissions (5 to 7%)
Table 6.5a Schooling status of children of 6-14 years
(% Mothers)
________ Centres with
Trained AWW Untrained AWW
All in school
Some in school
None in school
81
11
8
children
* S'lgnifu iui( in 5% level < if significance
435
76(2 = 3.42)*
15
9
I
351
I
Fig.6.4 Schooling Status of Children
of 6-14 years in the Household
/:
<•/ :•
■■
Scrne in school
XSome in school
it
None in school
'
'l ■
i •
.
.
8
J
s •
15
None in
school
feSBS 9
‘rt
8
to
All in school
81 +
■
/
All in school x
76+
Trained
Untrained
Significant at 5% level of significance
!
u
44
M»»b
■f
About one fourth of the AWWs reported to be having problems in organising the
pre school sessions regularly due to various reasons. However, the AWs who
received the innovative refresher training were able to organise die pre school
sessions every day.
The Pre school sessions were reported to be usually held for about 2 hours 45
minutes every day with games, songs and telling stones being the major pre schoiil
activities.
Participant observation of the AWCs revealed better performance of the trained
AWWs in terms of regularity, attendance, time spent and use of pre school aids
The refresher training imparted to the AWWs had a positive influence on the use
of integrated approach for conducting pre school sessions.
Schooling status of the children of 6-14 years was noticed to be better in the
villages with trained AWWs with all the children of 6-14 yrs in the household
currently in school in majority (81 %) of the households.
45
IMM,
■i
CHAPTER 7
WOMEN’S KNOWLEDGE & AWARENESS OF HEALTH & CHILD CARE
PRACTICES
• ii
'to
ti
Knowledge and awareness of various health and child care ;practices will
V be crucial to
improve the health and nutrition status of the child. Having observed better health and
nutrition status of children from die centres with trained AWWs, we make an attempt in
this chapter to understand the situation regarding knowledge and awareness of mothers
about the relevant aspects.
7.1
IMMUNISATION
CRild Immunisation
Attempts were made in the present study to find out the extent of awareness as
well as utilisation of the immunisation services provided to the child among the
mothers. Analysis of this data is presented in Table 7.1a.
Spontaneous awareness of foe immunisation services provided to foe child was
low among foe mothers of 0-6 years children though it was slightly better among
foe mothers from the centres with trained AWWs. The difference between foe
mothers from the centres with trained and untrained AWW was found to be
statistically significant at 5% level of significance.
Aided awareness about the specific injections / doses of immunisation given to the
child was very high across the centres irrespective of the training status of the
AWW. More than 90 per cent of the centres were aware of BCG, OPV and DPT
Awareness of the Vitamin A drops was low among the mothers with a child of 1 -2
years from centres with untrained AWWs. Level of awareness about Vitamin A
drops was significantly higher (at 5% level of significance) among the mothers
from the centres with trained AWWs. Perhaps the trained AWWs might have
created greater awareness among foe mothers about child immunisation making
use of foe improved communication ability in the post refresher training period.
Improvement tn nware.nesK about the child immunisation among tire mothers was
icporled by the community leaders: as an important post ICDS change in the
village
Blit gaps in the awareness about Measles and Vitamin A were visible. Hence IF!C
programmes should focus upon increasing awareness of Measles and Vitamin A
drops
ii
47
Table 7.1 a Awarep^s about Child Immunisation among Mothers
(% Mothers)
_________ Centres with______
Trained AWW f Untrained AWW
Spontaneous Awareness of
Immunisation of children
36
30(z=-5.08)*
Total No. of mothers with 0-6 yrs
child
940
668
94
97
92
80
61
94
96
91
78 (z=1.06)**
49 (z = 5.22,)*
Aided awareness of °
BCG
OPV
DPT
Measles
Vitamin A Drops
Total No of mothers with 1-2 vrs
child _
'271
271
0 1 otal exceeds 100 due to multiple response
* Statistically significant at 5% level of significance
** Slfrh.sticiiily not significant at 5% level of significance
198
Fig.7.1 Awareness about Child
Immunisation
i
I
I
% Mothers Aware
120 r—-----------
100 - ■94
94
97
96
1
92
I
80 78
80 L
60
61
-I
i
40
49*
■I
A
20 0 -'-L
BCG
OPV
DPT
Measles
Immunisation
L„„] Trained
Untrained
I
Significant at 5% level of significance
Vitamin A
iI
48
hnmunisatioii Provided to Pregnant Women
<7
AU the women with a child of 0-6 years child and mothers with a child of 0-2 years
were asked a few questions about the immunisation provided to the pregnant
women. Analysis of this data is presented in Table 7.1b.
Spontaneous awareness of IT injection was low among the mothers of 0-6 years
child. But die extent, of awareness was significantly higher among the mothers
from centiea with tnuned AWWs (29% Vs 21%).
however, more than four fifth (88%) of the mothers with a child of 0-2 years
reported awareness of IT injection (upon aiding).
Me 7J h Awareness about TT among Mothers
Centres with
Trained AWW Untrained AWW
SpQnl«19O«L.awflrene,v5.32f
7T Injection
29
21 (z “ 7.3))*
Total No of mothers with 0-6 years child j
940
66 H
Aided awareness pf
TT Injection
88
88
Total No. of mothers with 0-2 years child
497
385
u
49
7.2
M«M
HEALTH CHECKUPS
-/
All tiie motliers interviewed in the study were asked about the service of health
checkups provided by the AWW and health functionaries like ANM, LHV and
MO. Analysis of this data is given in Table 7.2a.
More than one third of the mothers from the centres with trained AWWs (36%)
were aware of the general health checkups carried out at the AWC. 'Hie
corresponding figure for the centres with untrained AWWs was 23 per cent The
difference between the centres with trained and untrained AWWs was found to be
statistically significant at 5% level of significance.
Spontaneous awareness about the health checkups carried out for the pregnant
women was very low among the mothers. However, upon aiding, the awareness
levels have gone up substantially. About tiiree fourth of the mothers were aware
of the health checkups carried out for the pregnant women.
Awareness of Health Checkups
(% Mothcn)
I__________ Centres with
j Trained AWW Untrained AWW
Health Checkup (General)
Spontaneous awareness
36
23 (z=ll 27) •
Total No. of Mothers with 0-6 yrs child
940
668
8
6
940
668
Aided awareness
76
76
wdh 0-2 yrs child
* Significant at 5% level of significance
497
385
Health Checkup (Preg. Women)
Spontaneous awareness
Total No of Mothers witli 0-6 yrs child
I
I
(
I
Fig.7.2 Awareness about Health Checkups
ZZI
"L( Spontaneous)
23 '
Preg. Wbfnen(Spont)
I8
16
I
I
76
Prag Women (Aided)
5
*
Z6
__i____
0
20
40
60
80
100
% Mothers Aware
L—! Trained
Untrained
I
p Significant at 5% level of significance
i
u
SQ
73
KEFERRA1, SERVICES
■!
On being asked about the various services provided by the AWW, 12 to B
percent of the mothers with a child of 0-6 years mentioned about the re for al
services. This indicates low levels of (spontaneous or unaided) awareness about
the referral services.
7.4
TREATMENT OF MINOR AILMENTS
In response to the question on various services provided by the AWW under the
ICDS, B to 14 per cent of the mothers with a child of 0-6 years mentioned about
the service of treatment of minor ailments. That is, spontaneous awareness about
the treatment of minor ailments was low among the mothers irrespective of the
training status of the AWW.
11
Meat
Si
SUPPLEM I NTAKY FEEDING
■r
Proper utilisation of any service depends to a greater extent on the awareness of
such service among the beneficiaries. All the mothers with a child of 0-6 yettns,
0-2 years and 1-6 years were asked a few questions to find out the extent of
DWiucncns of the service of supplementary feeding. Analysis of this data
presented
in Table 7.5a reveals higher levels of awareness about the
supplcmentiuy feeding service among the mothers. But the problem is that not all
the mothers with a child of 0-2 yrs have heard about the supplementary food given
to the pregnant women (even after aiding by the interviewer). This bnngs out ll>e
necessity to educate the mothers in general and the pregnant women in particular
about the supplementary food given to them during the pregnancy. Supplementary
food given to the children was almost universally known.
Table 7.5a Awareness about Supplementary Food
(% mothers)
Centres with_______
Trained AWW Untrained AWW
Spontaneous Awareness
Supplementary foodfpreg women/children)
84
85
Total No. of mothers with <0-6 yrs child
940
668
Aided Awareness
Supplementary food (pregnant women)
82
82
Total No. of mothers with 0-2 yrs child
497
385
Supplementary food (children)
99
99
Total No of mothers with a child of
1-6 yrs
712
479
4 <4
07492
—
•sf-
44Z
I
u
52
7.6
M«M
GROWTH MONITORING
■f
On being asked about the services provided by the AWWs, only 6 to 8 per cent of
Ihc niolhers with a child of 0~6 years mentioned (spontaneously) about the
pcnodic weighing of the children (fable 7.6a). After aiding, the levels of
awareness have gone upto 81 -84 per cent. The message is that still some of the
mothers were not aware that the AWW weighs the children regularly at the
anganwadi centre.
Proportion of mothers who were not aware of &e periodic weighing was
significantly higher among tlie mothers from the centres with untrained AWWs.
Tabic 7.6a Awggness about Periodic Weighing
(% Mother n )
________ Centres with
Trained AWW
Untrained AWW
I
I
I
I
Awareness of weighing
Spontaneous
Aided
Not aware
8
84
8
81
13 (z = 6.68)*
Total No of mothers with < 6 yrs child
940
668
* Significant at 5% level of significance
6
Fig.7,3 Awareness about
Growth Monitoring
I
i
i
K-
So onta
neons
Aided
8
84 eg
gf
< : < y Not aware
Trained
i
iSponta
■ neons
" 6
Aided
81 Z
8+
w
/ Not aware
13 +
b
Untrained
+ Significant at 5% level of significance
I
H
53
To sum up
'f
Levels of aided awareness of BCG, OPV and DPT were 'very high among the
modiers irrespective of the training status of the AWWs. Extent of awareness
about Vitamin A drops was significantly higher among the mothers from the
centres with trained AWWs.
Extent of spontaneous awareness about TT given to the pregnant women was
significantly higher in the centres with trained AWWs in spite of low levels of
awareness across the centres irrespective of the training status of die AWWs.
Aided awareness about TT for pregnant women was very high among the mothers
irrespective of the training status of the AWWs.
Extent of awareness of the general health checkups was significantly higher among
the mothers from the centres with trained AWWs. Even in these centres, only one
third of the mothers were aware of it indicating low levels of awareness about the
general health checkups among the mothers.
About three fourth of the mothers were aware of the health checkups carried out
for pregnant women.
Awareness about referral services and treatment of minor ailments was low among
the mothers
Almost al! the mothers (99%) were aware of the supplementary food given to the
child while only B2 per cent were aware of the supplementary food given to the
pregnant women
Most of the mothers (87% to 92%) were aware of the growth monitoring or
periodic weighing of the children carried out by the AWW at the AWC. Extent of
awareness of growth monitoring was significantly higher among the mothers from
the centres with trained AWWs.
54
CHAPTER 8
UTILISATION OE SERVICES BY MOTHERS AND CHILDREN
u
53
Any improvement in the awareness and knowledge of any service would be useful and
effective only when there is a change in the utilisation pattern of that service. In this
chapter, results pertaining to utilisation of various services by the children as well as the
mothers are discussed.
8.1
IMMUNISATION
Children
All the mothers with a child of 1-2 years were asked a series of questions relating
to the child immunisation - whether the child received the immunisation and the
number of doses received. Analysis of this data is presented in Table 8.1a,
Table 8 In reveids almm-t universal utilisation of BCG,. OPV and DPI' in al! the
ccmtres nicspective of the training status of tire AWAV. Proportion of children
immunised against mensles was less in the centres with untrained AWWs.
compared to that in the centres with trained AWW’s. Same holds good for Vitamin
A drops also. Merc lignin, die difference noticed between the centres with trained
and untrained AWWs was found to be statistically significant (at 5% level of
significance).
Due to liighor levels of awareness as well as utilisation, immunisation piogriimme
seems to be effective across the AW centres with the effectiveness being moie
significant in the centres with AWWs who received the innovative refresher
training.
Better intciaction ability and enhanced interest (mentioned by tl>e
functionaries as the benefits derived from the training) might have contributed lo
the improvement in performance of the trained AWWs with regard to utilisation of
the child immunisation services.
Most ot tiie mothers (95%) with a child of 0-5 years interviewed in the study
reported that all their children of 0-5 years received the pulse polio drops on
December 7, 1997 (Table 8.1a). This perhaps indicates the success of the pulse
polio programme in the study area
I
d
56
Table 8.1 a Immunisation received bv child
■ f
_____ Centres with
Trained
Untrained
AWW
AWW
% of children received
BCG
99
99
Total No. of mothers aware of BCG
256
186
OPV
98
98
Total No of mothers aware, of OPV
264
191
DPT
98
98
Total No of mothers aware of DPT
250
181
Measles
95
89 (z = 4.79)*
Total No of mothers aware of Measles
218
155
Vibuiun A
91
87 (z^ 2.77)'
Total No of mothers aware of Vitamin A
164
97
0
1
95
4
1
Pulse Poho (DEC *97)
Half
Three fourth
AU
No response
Total No. of mothers with 0-5 years child
941
* Statistically significant at 5% level of significance
1
95
3
668
r"
i
Fig 8.1 Immunisation Received by Child
I
i
Immunisation
879'
Vitamin A
i
i
Measles
I
DPT
98
98
OPV
58
98
BCG
i$9
99
!
I
’ — ------------------1--------------- ------------------------ ------------- L-------------- -_________ __ - - -
o
20
40
60
80
% children received
L—] Trained
: Significant at 5% level of significance
v
~——
■
» ■
»—- ■ -
_
Untrained
UJ
Ch
E»
.i.___
100
120
u
S7
M«M
Analysis of the data on number of doses received by the child presented in Table
B. Ib reveals that BCG and Measles - given only once - were received by almost all
die children properly, hi case of OPV and DPT, about 10 per cent of the children
could nol complete the schedule us they dropped out after receiving one or two
doses. Further probing regarding the reasons for not providing complete
immunisation schedule revealed that the mothers were not aware that all the three
doses need to be given. Some of the mothers disclosed, during the informal
discussions, that they were not particular about tire importance of all the. three
doses. Hie issue here is that there is a need to ensure that the child who received
the 1st dose of OPV/DPT continues to receive the subsequent doses.
All the children (of 1-2 years) were supposed to receive at least two doses of
Vitamin A drops. But 70 per cent of the children received only one dose and
about one fourth of the children received at least two doses. Here again, mothers
were not aware of the number of Vitamin A doses need to be given to the child
and hence Ib.C activities ol the programme should address this issue.
I.
u
M*9E
■!
I able H. lb No. of doses received
________ Centres with
Trained AWW I Untrained AWW
%_of children received
BCG
( h»r.
Two
No response
94
4
2
94
3
3
Total No of mothers reporting child recd BCG
253
185
1
Three
No response
2
7
88
3
8
89
2
Total No. of mothers reporting child recd OPV
260
188
One
Two
Three
No response
2
8
86
4
1
7
89
3
Total No. of mothers reporting child reed DPT
246
177
Measles
One
Two
No response
95
3
2
93
3
4
195
147
Three
Four
No response
71
9
15
I
5
70
3
20
'mothers reparbny child recd Vrt A
143
88
OPV
One
Two
lotal No. of mothers reporting child recd
Measles
Vitamin A
One
Two
i
I
6
59
’-■■i
Pregnant Women
Analysis of the data on utilisation of immunisation service by the pregnant women
is presented in Table 8 1c. On being asked whether they received the IT injection
during the last pregnancy, 87 to 89 per cent of the mothers replied affirmatively.
Of these., almost 90 per cent received two doses of TT The first dose was taken
during 3-5 months of pregnancy wliile the second dose was received during 6-7
months.
The task before the functionaries is to make efforts to ensure that the 2nd dose of
TT is also given to the small proportion of 5 to 8 per cent of the mothers Lack of
knowledge, inconvenient timings, lack of trust, and inconvenience in leaving home
were mentioned as the major constraints in taking TT. These problems can be
resolved by effective inter personal communication and motivation so that the
women start feeling that IT is necessary', important and trustworthy.
Table 8.1 c IT Injection
(% Mothers)
Received IT
________ Centres with_____
Trained AWW } Untrained AWW
89
87 (z= 1.72)**
Total No. of mothers with 0-2 yrs child and
aware of TT
437
339
No. of dpscs taken
1
2
No response
8
91
1
5
93
2
2
71
25
2
I
74
23
2
o
1
13
84
When received
1st
1-2
3-5
6-7
No response
2nd
1 -2
3-5
6-7
No response
16
80
-j
Total No of mothers with 0-2 yrs child and
recd TT________
** Not significant at 5% level of significance
389
i
70S
-* -w
——-J
Fig.8.2 TT Injection (Pregnant Women)
Not received
I
Hecelved t>::
89
'1
^■7
11
Aeceivad
87
w
Not received
k
13
II
V.--
Trained AWW
Untrained AWW
I
i
i
u
60
8.2
M«»b
HEALTH CHECKUPS
Dettuls itboui the tiervicc of periodic health checkups provided during the ante
natal period are presented in Tabic 8.2a. Proportion of the mothers who had check
ups during the hist pregnancy was significantly higher among the mothers from (he
centres with trained AWWs. Most of these (pregnant) women had the first health
check up only after the 3rd month of pregnancy. Almost half (46 to 49 per cent)
of (he molliCTs had the first check up after 4 months of pregnancy. Proportion of
such women was slightly less among the mothers from tire centres with train, d
AWWs.
Majority of the mothers (67 to 69 per cent) had 1 to 3 check ups during die 9
month period of pregnancy About 12 per cent of the mothers from the centres
with trained AWWs had 6 to 9 checkups while only 8 per cent of their
counterparts from the centres with untrained AWWs reported so.
General examination (71 to 77 per cent) followed by blood test (53 to 56 per cent)
emerged as the major activity carried out during the checkup.
About one third of die mothers got weight measurement and blood pressure
reading done during the check ups. Urine test, was earned out in case of one fifth
of the mothers.
Almost half of the mothers had the weighing done only once or twice during t))e 9
month period of the last pregnancy. Only 9 to 11 per cent of tire mothers got
weighted 5 or more times during the nine month period. This again needs
attention as frequent weighing is a crucial input to assess the growth and well
being of the unborn child.
Regular weighing of the pregnant women must be given more emphasis by the
• AWWs as this service is provided by them locally whereas rest of the services like
unnc test, blood test etc can not be earned out locally or by themselves (AWWs).
u
61
we»Ei
AWW is expected to visit the pregnant women .so as to provide nutrition and
health education regarding the ANC services, maternal diet and oilier related
issues. Towards this end, attempts were made in the present study to ascertain die
facts about the same. More than half of the mothers from the centres with trained
AWWs reported about the visits by the AWW during their last pregnancy. On the
other hand, only 39 per cent of the mothers from the centres with untrained
AWWs were visited by the AWW during the pregnancy. Thus, difference
between the trained and untrained AWWs in terms of visits by them to the hounes
of pregnant women was visible and was found to be statisticany significant at 5%
level ol significance.
Centres with trained AWWs present a better picture in terms of utilisation of the
service (i.c health cheek up), total number of checkups, various tilings done
during the checkup, and visit by the AWW during the pregnancy indicating better
perfoitniuice of (he (mined AWWs.
On being asked about the reasons for not having health checkups during the last
pregnancy, almost half of the mothers from the centres with untrained AWWs
reported that they did not know enough about the service. Other problems /
constraints mentioned relate to non-provision of the service by the AWW/ANM,
inconvenience to leave home, and non-suitabiiity of timings. The untniincd
AWWs need to make earnest efforts to educate the mothers about the importance
of health checkups during die pregnancy.
Issues emerging from the above discussion relate to early initiation ol the health
checkups, frequency of checkups, importance given to the various components of
the health checkup, and frequency of weighing.
I
M»9t
62
Table 8.2a Health cheekups - Details
_______ (% Mothers)
_________ Centres with
Trained AWW Untrained AWW
Had Health checkups
85
78 (z = 4.97)*
Total No. of mothers with 0-2 yrs child
and aware of checkups
378
366
1 - 2 months
3’4 months
5-6 months
7-8 months
No response
3
48
37
9
3
3
47
42
7
1
Total No. of mothers with 0-2 yrs & had checkups
321
286
7
25
37
13
6
12
2
7
23
37
12
11
8 (z = 3.29)*
2
Blood test
Weighing
77
56
37
BP
36
Urine test
23
71
53
36
30
25
Wl
wssJhc.kLvhcdsui?
Total No. of checkups
1
2
3
4
5
6-9
No r esponse
'BWLdeQ.e^iuri.UR checkup r ’
Genl. Exammaljan
No. of times we)nhcd during pr emancy
1
’
"
30
29
■7
3
4
5+
No response
18
Visited by AWW during pregnancy
Total No. of mothers with 0-2 yrs child and had
checkups____
* significant at 5% level of significance
3 Total exceeds 100 due to multiple response
j
I
f
20
27
18
10
9
3
II
9
57
39 (z = 8.87)*
321
286
16
Fig.8.3 Health Checkups (Pregnant Women)
nave
Did not have
k
-1^
h ad Isf
Ch
Had
■
7P -r
i o
Trained AWW
+ Significant at 5% level of significance
f
5;/
Untrained AWW
H
63
83
GROWTH MONITORING
Details relating to child weighing practices were obtained from the mothers wi(h a
child below 6 yrs of age The results are presented in Table 8.3a.
Three fourth of tire mothers reported that diey got the youngest child ever
weighed. Incidence of low birth weight is one of the causes of higher inlant/child
mortality in India and its states. To find out the severity of the problem, all the
mothers were asked about weight of the child at the time of birth. Analysis of this
data presented in I able 8.3a reveals that the problem was not so intensive in the
study area.
It is interesting to note that more than four fifth (82 to 85 per cent) of the children
were weighed either at the time of die birth or during the first month after the
birth. In case at institutional delivery, die child is usually weighed at the institution
immediately after the birth. In case of home deliveries, the weight of the new
born child is usually recorded by the AWW during the first month after the birth.
About I S |o 18 pci cent of the children were not weighed at the time of the biith
or during the first month after foe birth. Mothers of these children need to
sensitised about the weighing at the time of birth or immediately after the birth.
All foe children below 3 years need to be weighed every month and foose of 3 6
years need to be weighed once in every three months by the AW^Ws All the
mothers were asked about the number of times the child was weighed during the
12 months period before the survey. More than half of the children were weighed
for 1 to 3 times in the reference period (12 months). While only 12 to 10 per cent
of the children were weighed for 7+ times in one year.
Analysis by the age of the child revealed that the children of below 3 yeius of age
were not regularly weighed while the pre school children (3-6 years of age) were
weighed more regularly. Thus, frequency of weighing needs to be incicased lor
the children below 3 years of age.
The weighing was done mainly at the Anganwadi centre. Most of the mothers (H7
to 88?t>) reported that foe AWW interacts with them after weighing foe child.
AW-Vs mostly inform the mothers about tire weight of the child. Other activities
reported include telling about the care to be taken, kind of food to be given, and
need for regular weighing. The trained AWWs were able to educate foe mothers
about foe kind of child care measures to be taken up and the kind of food that
needs to be given to the child. The (raining they have received might be helping
them to communicate fieely with foe mothers. This again is a positive sign, which
muicnies ine posiiivc mnuenve or inc training on service ceiivery and qualiiv of
C3JC.
M«»t
64
Tiiblc 8.3a Child Weighing Practice
(% Mothcin)
_________ Centres with
Trained AWW Untrained AWW
~ ".. ~ 75
~
75''.......
Ever got child weighed
Total No. of mothers < 6 yrs aware of weighing
789
Ml
Birth weight
*2.5 kgs
2.5-3.0 kgs
3.1 - 4.0 kgs
4.1 + kgs
Not weighed
Do not know I can’t say
7
27
14
1
18
32
1
26
9
15
38
No. of times weighed (last 12 months)
1-3
”
'
4- 6
7- 9
10-12
Can’t say
56
22
4
12
6
58
20
2
10
10
Place of weaghmg
AWC
SC/PHC
Can’t say
85
13
2
86
12
2
Interaction with AWW alter weighing0
Tells nothing
Informs weight
Tells about care to be taken
Tells about food to be given
Tells about regular weighing
13
87
47
37
14
12
88
35 (z-7.69)’
31 (z-M.OO)*
15
591
409
f
i
Total No. of motheix with < <(’-Yrs_chiid ever weighed j
* Significant m ■>% level ol significance
(J lotal exceedb 100 due to multiple response
7
Fig.8.4 Post Weighing Interaction
(AWW-Mother)
3
12
Nothing
I
I
I
i»
i
informs weight
i
Tells about care
&
w
r'-f 31+;
I 14;
FteguDar weighing
3 15
0
!
o
TZ]
TelliS about food
I
487
ae
.«r_.
I
i
. 1 ,
20
40
L
J Trained
Significant at 5% level of significance
___________
60
Untrained
80
100
r
Fig.8.5 No. of Times weighed (Last 1 yr)
I
70
% Children Weighed
i
i
i
60
56 ; 58
50 -
40 30 -
22
20
Ch
20
cr
12
10 -...
0 --
_.±_ 2
__ I___ _______
____
1-3
7-9
No. of times weighed
L—J Trained
I
Untrained
i1
65
8.4
M«»E,
SUFPLFA1ENTARY FOOD (MOTHERS)
■ /
Utiliwlion by pre^nwiDyomejl
Mere awareness about a service is not sufficient and it is expected that the
awareness (ends to utilisation so that changes take place as envisaged in the project
documents
Analysis ol the data relating to utilisation of the service of supplementaly food l>y
the pregnant women presented in Table 8.3a. indicates moderate levels of
utilisation. About one thu d of tire pregnant women did not receive supplementiu y
food from die AWC during the last pregnancy.
The kind of food given to the pregnant women include :
- energy food (unde j for 2 days in a week
- nee (chitranna) for 2 days in a week and
- sweet (pongal) tor 2 days in a week
The supplementary food is given to the pregnant woman right from the date of
confirmation of the pregnancy. On being asked about the month of pregnancy in
which they starred taking the food from the AWC, about three fourth of the
mothers reported to have started during 1-4 months of pregnancy. About one filth
of the mothers started taking the supplementary food after 4 months of pregnancy.
This again needs attention from programme point of view. Efforts must be made
to ensure that these women start taking the supplementary food much earlier. By
and large, the food was received either upto 9th month or delivery, More women
from the villages with trained AWWs received food til! delivery.
The findings presented above bring out the necessity for effective IEC pivgranune
regarding the time when a pregnant woman should start taking the supplementary
food. Ihis can be earned out through housevisits or NEED group sessions.
H
66
The supplementary food is given to the nursing mothers upto 6 months alter the
delivery. But a sizeable proportion (45 to 4R per cent) of the nursing mothers did
not receive the supplcmcmary food after the delivery. About one fourth of the
nursing mothers revxnvcd the supplementary food till 6 months or were still
receiving the food at the time of the survey. This can be considered as one of the
gaps in the service, delivery.
The pregnant women /nursing mothers are expected to be given the supplementary
food for 25 days in a month. On an average, pregnant women/nursiny mothers
from the centres with trained AWW received die food for 16 days while the
corresixmding figure for their counterjrarts from the centres with untrained AWWs
whs 19 days.
The programme lays emphasis on spot feeding so that the pregnant wornnn/'niirsing
mothers consumes the entire quantity of the supplementary food given to liei so as
to meet her nutritional requirements.
More than half of the pregnant
women/nursing mothers shared the food with others. Proportion of such womesi
was less in the villages with Trained AWWs compared to the villages with
untrained AWWs.
The IEC activities of the programme should address the issues like early initiation
of supplementary feeding, continuation of the same till the child becomes 6
months old, receiving it regularly and spot feeding
Performance of the trained AWWs appears to be better compared to their
counterparts who could not receive the training in terms of providing
supplcmentiuy food for pregnant women/nursing mothers. The refreshci training
appears to have helped the AWWs in enhancing their interest in providing the
supplementary feeding
Findings from the pditicipant observation of tiie AWW/AWC also corroborate the
above findings.
ii
weM
67
Table 8 4a $UBp£gtn^ntiiry food utilisation by pregnant women
(% Mothei k)
Centres with f
Trained AW UntrainedLAWW
Received suppl. food during last pregnancy
67
69
Total No. Of mothers with 0-2 yrs child and
aware of supplementary food
408
316
When started taking food
I - 2 months
3 - 4 months
5-6 months
7 - 8 months
Can’t say
Received Till
7th month or earlier
Sth month or earlier
9th month / delivery
Can't say
f
ti
I
Received after delivery tiji
3 months or less
4-5 months
6 months
Still recaving
Not received at all
Can’t say
31
28 (z-1 46)**
46
16
46
2
5
17
3
6
18
5
73
4
26(^4.31)*
6
65 (H.00)*
3
12
12
14
14
45
3
12
14
13
12
48
1
No, Of days food received/month
Upto 10
II - 19
20 - 25
26
I
No response
Mean
Total No. of mothers with 0-2 yrs child and recd.
supplementary food
j
Whether shared with others
Yes
............ ~ ””
Signifiv.iuit ui s'Hi level i>( sinniticancc
16.4
20 (z - 6.31)*
4
52 (z - 5.45)*
13
II
19 1
273
218
58
42
61
39
273
218
16
9
)
}
No
j
Total No of mothcix with 0 2 yns child and reed. !
supjri. food
!
*
32
3
40
j
Fig.8.6 Supplementary Food Utilisation
by Pregnant Women (Last Pregnancy)
Recd.last pregnancy
;r=—t-1
. -K'
tc.—
I 87
:1 69
i 31
28
Started 1-2 months
i
I 18+
Recd. till 7th month
t
26
81
Reed, till Sth month
40
J4- 73
(b
60
6*
% Mothers
Shared with others
I
0
1 Trained
____ k_L______
20
80
Untrained
+ Significant at 5% level of significance
100
u
6R
8.5
SUPPLEMENTARY FOOD - CHILDREN
All the children of 6 months - 6 years of age are also expected to be given
supplementary food by die AWW for 6 days in a week.
All the mothers with a child of 1-6 years were asked a series of questions relating
to utilisation of supplementary food by the children. Analysis of die data is
presented in Table 8.5a
Most of the mothers (86 to 87 per cent) reported thabthe child had ever received
the supplementary food from the AW centre. And most of these children were still
receiving the supplementary food from the AWC at the time of the survey.
Almost four out of live children received the supplementary' food for nt least 21
days in a month. This is a good sign because regular feeding is useful for the
child
Of all the children who receive food at home, more than half share die same with
olners. fhis needs to be discouraged because the supplementary food given to the
child would suffice his/her nutritional requirements. And hence, efforts to ensure
more spot feeding arc needed to improve the situarion.
fable 8.5a Supplemenduy food utilisation by children
(% mothois)
__________ Centres with
!
Trained AWW ! Untrained AW W !
II
85
87
82
i
85
Child ever received supplementary food
Child still receiving supplementary food
Total No of mothers with 1-6 yrs child & aware
of supplementary food
702
474
26
j Can’t say
6
4
8
60
19
3
1
4
8
63
17
7
j Shared with others
55
59
N2_£lidays./Qltlftth .received Jfoqd
Upto 10
11-15
16-20
21 - 25
j Total No. of mothers reporting that food taken j
I at home
<
1
_
-
—■■■.
——
—
________________ _________
_____
I
I
I
<
128
77
Fig.8.7 Suppl. food utilisation by
Children
I
I
% Children
100 -r------------------
i
I
85
80 4
i
I
60 j....... i
40 J '
CD
20 H
0
Evisr Received
E—J Trained
i
I
Currently Receiving
Untrained
u
69
To sum up
7
Extent of utilisation of the child immunisation services was very higl) across the
study area. Proportion of children who received Measles Vaccine and Vitamin A
drops was significantly higher in the centres with trained AWWs.
Proportion ot the mothers who received TT injection during the last pregnancy was
higher in the centres with trained AWWs.
Proportion of the mothers who had healtli checkups during the last
last pregnancy
pregnancy was
also significantly higher among the mothers from the centres with trained AWWs.
Mothers from the centres with trained AWW had significantly higher number of
health checkups dining the last pregnancy than their counterparts from the centres
with untrained AWWs 'fhese mothers had greater interaction with the (trained)
AWW during the last pregnancy.
About three fourth of the mothers got their children of 0-6 years ever weighed.
Children from the centres with trained AWWs were weighed more frequently or
regularly compared to their counterparts from the centres with untrained AWWs
Trained AWWs were observed to be performing better in terms of post weighing
interaction with mothers regarding the care to be taken, food to be given etc
More than two third of the mothers reported to have received the supplementary
food during the last pregnancy. Proportion of mothers who received the
supplementary food till 9th month ot pregnancy i delivery was significantly higher
in the centres with trained AWWs.
More than four fifth of the children were receiving supplementary food from (he
AWC Sharing ot food was more commonly observed among the children from
the centres with untrained AWWs.
i1
70
!
CHAPTER 9
CONVERGENCE OF SERVICES
u
Meat
The ICDS programme envisages close coordination between ICDS, and olher
departments providing supportive services such as Adult Literacy, Education,
Rural Development. Health, Pttnchayal Raj etc.
To get an idea about the involvement of the AWWs in the activities of other
departments, all the AWWs were asked about the proportion of their time devoted
to work of non ICDS departments. In response to this question, about half (51-52
per cent) of the AWWs reported to be spending about one fourth of the time on
non ICDS work such as Family Planning, Literacy, DWCRA, MSY etc. About J9
lo tl pci com of the AWWs devote about half of their time for non ICDS work .
this clearly illustrfttes the active involvement of the AWWs in promoting olher
suppornvc services. This is commendable in view of their busy schedule ut the
AW centre
Ihis observation was supported by the responses of othor
fimetionunes like Supervisor, CDPO, Assistant Director, PO and AW’IC
functionaries. The message is that the ICDS functionaries take active interest in
the programmes of other departments.
All the AWWs were asked about the specific joint activities carried out by tlivm
with the function ar ics of the health department. The success of the ICI >S
programme depends on the coordination between the health department mid ICI >S
as the health components covered under the ICDS need greater cooperation from
tiie health department.
Almost all the AWWs reported that they carry out joint activities with the health
functionaries - ANM, LHV and MO. The kind of activities carried out jointly by
the AWW and die health functionaries include ;
-
Immunisation (with ANM, every month)
Health checkups (with MO, ANM, LHV, once in 2-3 months)
j\nte and post natal care services (with ANM, every month)
NHED sessions (with ANM, every month)
Family planning motivation (with ANM, every month)
No significant difference was noticed between the trained and untrained AWWs in
terms ofjoint activities enmed out with the health functionaries
u
72
west
ITie extent of coordination between die health and ICDS functionaries al higher
levels was also noticed to be high with almost all the supervisors arid CDPDs
reporting that they carty out the activities listed below, with the health
functionaries (like LHV and MO).
- Joint meetings nt sector and project level
- NHED camps
- Joint Supervision
According to the district level officials, block level coordination committees have
been iormed in ail the K
blocks of the district. The committee has Assistant
Commissioner as Chairman, CDPO as Secretary, and MO, BDO and BEO ns
members In some ot the blocks, committees are not able to meet regularly
Earnest elfoits to ensuie that the committee meet regularly to discuss and resolve
the problems will help in improving the coordination between the viuiouk
department';
All the ICDS fonctionaries were asked about the kind of help/assistance they
receive from the fonctionaries of other departments. All of them responded
positively and (he responses are as follows :
Education Depai tment ui providing (school) building for AWC
Rural Development & Panchayat Raj Deptartment in providing building /
accommodation for AWC
- BDO / Village Panchayat m providing fuel expenses for suppiemcntiuy
food preparation (Rs,75 per mouth per AWC)
— Health Deptartment in organising health checkups and immunisation
Sanitation Department in providing hand pump / drinking watei Koime
(near the AWC)
In many of the villages, Mahila Bala Vikas Samitlii was formed with the Woman
Panchayat Member as ihe chair person. This also lead to greater involvement of
the Gram Panchayat in the activities of die AWC.
The ICDS functionaries at various levels are satisfied with the way other
departments are helping them.
u
73
However, some of the constraints highlighted by the functionaries given below
need to be looked into hy the Programme Managers.
- Vacancy of about 50 per cent of tiie MO posts (one MO for 2 PHCs)
affecting the frequency of organising health checkups.
- Non availability of vehicle for joint visits
Some of the suggestions put forth by the functionaries to improve the convci-gcnce
of services include :
-
7’<>
Reguiar (montlity) review meetings as per the schedule
Joint visits
Joint workshops at btock/distnct level to discuss and resolve problems
Visits by the officials of other departments to AWCs during their visit to
the village.
yp
Hie AWWs reported their active involvement in the activities of non ICDS
departments providing supportive services in the villages like Family Planning,,
Literacy. DWCRA, MSY etc. The
senior officials also reported active
involvement of [CDS functionaries, in providing other supportive services. Joint
activities carried out by the Health Department and ICDS in providing health
check ups, immunisation, ante natal and post natal care services etc was also
highlighted by the functionaries of Health Department as well as ICDS. The study
also highlights the higher levels of coordination between ICDS mid other
departments like Health, Education, Rural Development, PanchayatRaj, Sanitation
etc So ICDS appears to be helping in achieving the convergence of different
services provided in the villages and urban slums.
Vacancy of MO posts, non availability of vehicle, and inability to have mgular
meetings emerged as the major constraints regarding inter departmental
cooperahon/coordination. The suggestions put forth by the functional ion include
regular review meetings, joint visits and joint workshops. To enhance the
coordination/cooperation between the Health Department and ICDS in the World
Bank assisted ICDS blocks of Andhra Pradesh, MODE has developed a strategy
which involves preparing monthly schedule for carrying out joint activities by the
fimetionaries of both the departments. Perhaps this can be tried out by the
Department of Women and Child Development in Karnataka also. Similiuly,
ICDS vehicle can be provided to the MO for attending die ICDS meetings and
visiting the AW centres. These steps could further enhance die extent of inter
departmental coordination / cooperation at vanous levels across the state
u
74
west
•
CHAPTER 10
COMMUNrrY PARTICIPATION
■/
iI
"5
’ • 7
Involvement of the local community leaders, mothers and mahila mandal members tn
AWC activities would go a long way in improving the utilisation of ICDS. Towards this
end, ail the AWWs are expected to make efforts to involve the local community in the
AWC activities. Active participation of die local community in the AWC activities can
be considered as an achievement of the AWW in mobilising the community support
'Die innovative refresher training imparted to the. AWWs is also likely to have a bearing
on die ability of Hie AWWs in mobilising community support as community
mobilisation/participation was one of the issues covered in die refresher tmining.
Improvement m the ability to interact with the CLs was perceived by the AWWs us one
of the benefits derived from die innovative refresher training. In this chapter, an attempt
is made to understand the extent of involvement of the local community in the ICDS
Programme and assess the impact of the refresher training on community involvement or
participation.
10.1 AWW’s RESPONSE
AJ! the AWWs interviewed were risked a series of questions about the involvement
ot community leaders, mothers and mahila mandal members in the AWC
activities
Table 10.1a gives tire results relaxing to die involvement of CLs, Mothers and
Mahila mandal members in the AWC activities.
iI
76
Table 10.1 a Activities in which CL, Mother and MMM help
’
(% AWWs)
I
______ CL_______ I_____ Mother_____
MMM
I
Activity
Fnuned_ Untrained! Trained I Untrained Trained Untrained
Preschool running
16
14
“i
/(
19
3
Suppl food preparation
16
15
27
20
1
i
(
Organising meeting
32
27
35
30
11
7
Arrange accommodation
29
23
4
4
0
0
Immunisation
I 10
6
35
26
0
0
<
Food distribution
3
3
16
13
1
Escorting children for
PSE/SNP
(
3
21
17
2
1
l
1I
Arranging drinking
I
water
4
3
7
6
2
5
i
No help
20 _ __ 24 __i
(z - ‘I
25
35_
(z = 11.38) *
1485
1180
62
_ 67
(z ” .3~23)'* ’
To£al_No. of AWWs
1485" J_ "'fl«O
CL - Community Lender
MMM =“ Mahila Mandal member
PSE-fPie School
‘
Education SNP *= Supplementary Nutrition Programme
®
Significant at 5% level of significance
Note Total exceeds 100 due to multiple response.
More tluui three fourth of the AWWs- reported about the involvement of the Cl.s
while more than half of tlie AWWs reported about the involvement of the Mothers
in the AWC activities. I his indicates higher levels of involvement of the CLs mid
mothers in the AWC activities,
Proportion of AWWs reporting about the help extended by the CLs, Mothcis turd
Manila mandal members was significantly higher among the trained AWWs And
the difference between the trained and untrained AWWs was found to be
statistically significant al 5% level of significance. Cooperation of the Community
Leader was more pronounced in activities like organising meetings and iiniuiying
accommodation, while involvement of the mothers was reported more in
activities such as organising meetings, immunisation, supplementary food
preparation, pre xcliool and escorting children to AW centre.
Fig. 10.1 COMMUNITY PARTICIPATION
% AWWs reporting help
I
80 r
80
i
i
76 +
I
75
I
65 +
5
-
I
I
’38
J
'—------------ 1
I
M
O
£u
0
Mother
Mahifa Mandal
Untrained
j
Significant at 5% level of significance
i 1
In case of the mahiln mandal members, help in organising meetings was mostly
mentioned by 7 to 11 per cent ot the AWWs. However, not much involvement of
the mahila mandal members was reported by the AWWs - trained' as well as
untrained. Most of the AW centres did not have maliila mandals - 62% trained
AWWs and 67% unti ained AWWs reported about non existence of maliila
mandal in their village.
Extent of involvement of the community leaders and mothers in ICDS activities
was found to be high in (he study area. This shows that the local community was
evincing interest in the ICDS activities.
Situation regarding the involvement of die community leaders in die AWC
activities appears to be significantly better in the centres with AWWs who received
the refresner training compared to the centres with AWWs who could not receive
the refresher training.
The innovative refresher training appears to have exerted positive influence on (he
community participation in the AWC activities. Improvement in the ability of (he
AWWs m mobilising the community support and communication skill, and
enhanced interest to perform better (reported as die benefits derived from the
innovative refresher training) could have brought in the desired and expcvled
changes in die conununity involvement or participation in the AWC activities
<>n being asked about the action to lie taken to improve the extent of cooperation
from the local community, the AWWs put forth the following suggestions ;
Creating more awareness about the ICDS
Organising meetings to motivate the community leaders, mothers end
manila manual members
Regular interaction between the senior functionaries / officials of ICDS and
mothers, community leaders and mahtla mandal members.
Assigning responsibilities to Community Leaders, mothers and nuJrila
mandal members.
Me»b
7S
■f
10.2 MOWER’S RESPONSE
All the mothers inter viewed in the study were asked about the mvolvemenl of the
mothcis in the AWC activities. 1 able 10.2a gives the analysis of their responses
Table 10.2a Uiyglvement of Mothers
(% Motiicrs)
j
Centres with
! Trained AWW j Untrained AWW
(;
32
25(z = 93(>)*
Mothers of the village help AWW
Total No. of Mothers
Mothers can help
Total No. of mothers who reported
Mothers do not help in AWC activities
f
(
I
j
i
I
941
668
34
29 (z- 3.02)*
640
501
Kind of activities
Weighing
Immunisation
Bringing children to AWC
Food preparation
21
37
39
13
Total No. of mothers who reported
mothers help
]
208
Note 1 otal exceeds 100 due to multiple response
Significant at 5% level of significance
Not significant at 5% level of significance
I
8 (z = 7.05)*
34 (z“ 1.22)**
34 (z = 2.02)*
6 (z = 4.52)*
167
More than one fourth of the mothers (25 to 32 per cent) reported that lhev help
the AWW in foe AWC activities. About one third of foe mothers reported Hint foe
mothers can help foe AWW in one way or foe other. That is, about two third of
the motlrcrs were either helping or willing to help the AWW. This indicates
moderate level of participation of the mothers in the ICDS activities.
H
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79
Table 10.2a reveals the difference in the extent of involvement of the mothers in
the AWC activities between the centres wife trained AW? and centres with
unnamed AWWs The difference between the two types of the AWCs in all the
cases were found to be stahsticttlly significant at 5% level of significance
More than half (54 to 66 per cent) of the mothers reported that they were either
already helping or can help the AWW. This is a good sign. However, the concern
is that 34 to 46 per cent of the mothers either did not report the involvement of
mothers or they were not optimistic about their future involvement Ihis tiuget
group needs to be approached and motivated so as to facilitate their involvenamt
and active participation in die ICDS programme.
'flic difference noticed between the centres with trained AWWs and untrained
AWWs in terms of extent of involvement of the mothers in various kinds of
activities (eg. Weighing) was observed to be statistically significant at 5 per cent
level of significance.
i
In spite of better performance in die centres with trained AWWs, involvement of
the mothers appears to be a problem area across the study area, as about two third
of die mothers reported that the mothers of the village do not help the AWW in her
activities. The reasons cited for this mainly related to lack of sufficient knowledge
about the ICDS programme and the kind of role the?/ can play. Some of the
motliers think that it is government’s responsibility to run the AWW centre tuid the
community has nothing to do with it This needs to be addressed through effective
communication and motivation campaign, with involvement of the senior
functionaries / officials.
Majority (65 to 75 percent) of the AWWs reported that the mothers in the village
help them in their activities, while only 25 to 32 percent of the mothers reported
so. Though the mothers were asked about the involvement of any of the mothers
in AWC activities, the mothers more often responded about their own
involvement. These mothers being mothers of small children may not be able to
get involved m the AWC activities, because of their preoccupation with household
chores and child rearing activities.
n
H
msm
To »um up
■j
Extent of involvement of the community leaders and mothers in the AWC
activities was observed to be more in the study area indicating active participation
of the local community in the ICDS activities.
Situation rcgiudmg the involvement of the local community in the AWC activities
was signiiicantiy better in the centres with AWWs who received the innovative
refresher training compared to those centres with AWWs who could not receive
the refresher training
H
H
ai
M«»fc
■!
CHAPTER 11
OTHER ISSUES
fl
>12
11.1 Nirnu HON AND I IE Aim EDUCATION - HOUSE VISITS
•/
AWWs provide Nutrition and Health Education to the women of the village
through regular house visits (inter personal contacts). Attempts were made in the
study to find out the status regarding NHED through house visits.
AWW5s response
AU the AV/Ws were asked about the frequency of house visits, the kind of houses
given priority, number of houses covered during the last visit and the time spent
with each woman. Analysis of this data is presented in Table 11.1 a and
Tabic 11.1b.
By and large, all the AWWs were able to make house visits. And most of them
reported that they go on house visits every day. Proportion of AWs reporting
daily house visits was significantly higher among the trained AWWs, compared to
the untrained AWWs,
I
A small proportion (I to 3 per cent) of the AWWs reported that they go on house
visits once in one or two weeks.
Majority of the AWWs (about two third) visit die houses on priority basis with
more priority given to the children not coming to Ute anganwadi centre,
immunisation drop out, and at risk mothers. Houses with referral cases, pre school
drop out, and grade III and IV children were also given priority by the AWWs.
Proportion of die AWWs giving priority of houses with mal nourished children and
at risk mothers was significantly higher among the trained AWWs.
About half of the AWWs reported to have visited 1-2 houses during the last time
they made house visits white more than 90 per cent of the AWWs visited 1-5
houses. On an average, the AWWs visited 3.3 to 3.6 houses in a day. The
difference observed between the trained and untrained AWWs was found to l>e
stahsticallv insignificant (at 5% level of significance).
u
83
About one fourth of the AWWs reported to have spent more than 20 niinutes with
each woman while another one fourth of the AWWs reported the time spent as 10
minutes.
More than three fourth of the AWWs make house visits everyday. But the only
concern is that some of the AWWs (1 to 5 per cent) were not visiting the houses
even weekly once as (Itcy stay in a near by village. They can easily visit tire houiies
by staying in the AWC village as the mothers can be met when they are available at
the houses. These AWWs need to be motivated to ensure that they make house
visits at least twice a week so as to provide the neccs.saiy NHED inputs to the
mothers
Tabic Illa House visrfr; (AWW’s response)
Able to do house visits
Trained
91
Total No. of AWWs reported house visits
1275
Frequency
Daily
Once in 2 days
Twice a week
Once a week
Once in 15 days
[
82
12
5
I
0
--S3
1030
i
75 (z “28 I)*
14
6
i
3
Visits houses on prionty basis
67
64
Total No. of AWWs
1485
1180
57
63
32
37
35
42
55
64
28 (z = 4.00)*
40
39
39 (z -2.50) ♦ i
991
758
Priority given to D
Immunisation drop our
Children not coming to AWC
Gr. ID <t IV children
Referral cases
Preschool dropout
At nsk mothers
I otai No. ot AWWs visit <>n priority basis
* Significant at 5% level of significance
C! I otal exceeds 100 due to multiple response
V.
I)
(
I“'LAWW<)
Untrained
f
I
(
[
t
I
Fig.11.1 Frequency of House Visitis
by AWWs
i
I
Twice a week
t
Once ir'i ■week
Ik
5 in 2 days
Im Once
■.
/
■
KMOnce
(•<<<•
■” week
<7
: i
t:::;: •.
Dal I *
i
Daily .
75* V<
Trained
ElBt
fe* C*S V
i
i
14
In 2 v/eers
Twice a'^weeK
T/
3
&
Untrained!
Significant at 5% level of significance
J
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1 able 11.1 b Petails about last visit ('AWWs response)
I
Trained
_(% AWWs)
Untrained
No. of houses covered
1 -2
3-5
6-8
9-10
55
38
4
3
52
40
4
4
Mean
SD
3.3
4.5
3.6
11.2
Time spqnt (minutes)
Upto 10
11-20
21 -30
31 +
25
46
23
6
26
42
25
7
Total No. of AWWs
1485
1180
Mother’s response
AH the mothers interviewed in the study were asked about the frequency of house
visits, time spent and issues discussed. Analysis of this data is presented in
Table 11.1c.
On being asked about the frequency of house visits by tire AWW. only 13 to 14
per cent of the mothers reported it as once in 1-2 days. About one fiftii of the
mothers reported that the AWW visits the houses monthly once. One plausible
explanation for these responses to be different from tire stated response of the
AWWs is that the AWW might have visited rest of the houses about which the
mother perhaps was not aware. The AWAV spent less than 10 minutes according
to majority of the molhers (42-44 per cent). The time spent by the AWW was
11 -20 Minutes according to one third of the mothers.
n
The discussion during the house visit by the AWW centered around immunisation,
pre school, health issues, supplementary' food and nutrition related issues Growth
muniioiitig was mentioned by a small proportion (3-5 per cent) of the mothuis.
huiici discussion has bi ought out the necessity to sensitise the mothers about (he
unpoi tance olTejjubu weighing of the child. Perhaps this is not receivina mleqmite
attention from the AWWs, while imparting Nutritional Health Education.
as
Table ll.Ic House visits (Mothers response)
[% Molhei t)
I________ Centres with
[ Trained AWW Untrained AWW
Frequency
Daily
Once in 2 days
Twice a week
Once a week
Once in 15 days
Monthly
Once in 2+ months
I
I
k
8
5
14
31
9
21
13
31
9
22
10
Total No. of mothers reporting HVs by A\W
594
454
Time spent (minutes)
Upto 10
11-20
21 - 30
31 +
42
33
20
5
44
39
10
7
49
31
50
27
52
43
(
i
I
9
5
H
Whal
Preschool
Supplementary food
Immunisation
Health issues
Nutrition
AN/PN Services
Family Planning
Growth monitoring
Total No. of mothers reporting HVs by AWW7
!_] Total exceeds I(X) due to multiple response
53
43
23
7
6
5
594
21
12
6
3
454
u
86
11.2 NHED GROUP SESSIONS
■7
AWVV*s response
All the AWWs are expected to organise group sessions or NHED meetings for the
mothers once in a month. Attempts were made in the study to assess the
performance of the AWWs in terms of frequency of the sessions, time spent,
issues discussed and use of the audio visual aids. Analysis of the data pertaining to
these issues is presented in Table 11,2a and Table 11,2b.
Almost all the AWWs reported that they organise NHED sessions. 'Ihe sessions
are by and large, organised every month (about two third reported so). About one
fourth of the AWWs organise 2-3 sessions in a month. (Table H.2a).
On being asked about the last session, most of the AWWs (80-89%) reported that
the last session was held during 1 to 4 weeks before the date of the sutvey.
Proportion of AWWs who organised the last NHED session more than 4 weeks
ago was significantly higher among the untrained AWWs. This indicates tliat the
trained AWWs organise NHED sessions more often.
More than four filth of the AWWs reported to have spent more than 45 minutes in
the hist Nt IHE> session.
Immunisation,, nutrition issues and health issues were the main topics discussed
during the NHED sessions. Other issues discussed included supplementary focal,
ante natal and post natal care, pre sdiocL family planing and growth monitoring
Here again, growth monitoring did not receive the priority it needs (only 6 to 7 f>er
cent of the AWWs reported about it).
Four fifth of the AWWs reported the use of audio visual aids during tiic session.
Chaits were used by most of the AWWs with immunisation card and poster being
the oilier aids used (Table 1 L2b).
Non availability of the aids (due to non replenishment) emerged as the major
constraint in usins audio visual aids.
The trained AWWs organise the NHED sessions more frequently and they use aids
during the sessions. Better understanding of the use of die audio visual uah was
perceived by the AWWs as one of the benefits derived from the refreshni tiuniing.
And this perhaps holds the key for the better performance of the trained AWWs
regarding the NHED gioup sessions.
u
M«9b
&7
Table 11.2aNHED Sessions (AWWN response)
■J
(% AWW)
f
Organise Nf lED Sessions
Total No. of AWWs
I
Tramerl
99
Untrained 31
1485
1180
Frequency
2-3 times a nwnth
Once a month
Once in 2-3 months
26
65
9
26
64
10
LastmyQii
Upto 4 weeks ago
More than 4 weeks ago
89
11
80
20
Time spent (minutes)
16-30
31 - 45
46- 60
61-120
121 +
10
9
37
34
10
9
H
15
14
14
Issues discussed 0
Pre school
Supplementary food
Immunisation
AN & PN Services
Health issues
Nutrition issues
Family Planning
Growth Monitoring
21
36
69
32
47
56
11
7
24
37
68
35
46
52
15
6
1471
1148
Total No. of AWWs organise NHED_______
□ Total exceeds 100 due to multiple response
Fig,11.3 Frequency of NHED Sessions
Ct,ce in
2-3 months
9
2“3 tin?es
month
Ones in
2*3 months
10 z
k 26
/' bo
f
2
J
Once a man th
64
Trained
I
71
7
Once a rnanth
66
' -3 nmea
a rrionm
Untrained
I
Fig 11.4 Last NHED Session
I
I
•'H 'A*?eks age
k
20
ZL
iI
i
I
I
i
4 weeks ago
89-
:^:^7
a»3Ci^;
^7
* 4 weeks
Trained
©
Untrained
i "Significant at 5% level of significance
J
11
870)
Table 11.2b Use of AV Aids by AWWs
•7
(% AWWs)
Use Aids
Trained
80
Untrained
78 (z- 7.96)*
Total No. of AWWs organise NHED
1471
1149
6
Type of ajd$ used D
I
Flip chart
Poster
Chart
Immunisation card
35
80
47
4
32
83
47
Total No. of AWWs used aids
1177
892
Do not have aids
No sufficient place to hang charts
Do not feel it necessary
Others
Can’t say
64
3
13
4
16
66
Total No. of AWWs did not use aids__________
□ Total exceeds 100 due to muftipie response
* Significant at 5% level of significance
274
237
Reasons for not using aids
6
12
4
12
u
S8
Mother^ response
On being asked about the NHEI> sessions conducted by the /\WW, 30 to 34 per
cent of the mothers reported that they were aware of such sessions.
All the mothers who were aware of die NEED sessions organised by the AWW
were asked about the frequency, time spent, issues discussed and AV aids used.
Analysis of this data is presented in Table 11,2c and Table 11 2d.
More than three fourth (76 to 83 per cent) of die mothers reported tliat llic Ni l ED
sessions are usually organised by the AWW at least once in a month. According
to more than half of the mothers, the last NHED session was organised 1 to 4
weeks before the date of the survey. The conclusion is that the NHED sessions are
organised as planned by die AWWs - trained as well as untrained.
Time devoted for the NEED sessions also appears to be satisfactory due to die fact
that more than half of the mothers reported the duration of the last session to be
more dian 45 minutes.
As regards tne issues discussed, food & nutrition and immunisation emerged as
the major issues, (jrowth monitoring, breast feeding, ante natal and post natal care
services and family planning were the other issues discussed. Here again, growth
monitoring appears to have not received much importance (only 11-19 per cent of
the mothers reported about it). Proportion of mothers reporting discussion about
issues like food and nutrition and growth monitoring was significantly higher
among die mothers from die centres wridi trained AWWs.
Use oi aids - mostly charts followed by posters and immunisation card - was
reported by more than half of the mothers. (Table 11.2d).
iI
89
<7
Table 11.2c NHED Sessions by AWWs
(% Mothers)
_________ Centres with
Trained AWW Untrained AWW
Frequency
More than once a month
Once a month
Once in two months
Less often
Last session held
1 -4 weeks ago
5-9 weeks ago
10+ weeks ago
Can’t say
i
I
38
38
18
6
34
49
13
5
53
20
21
7
59
19
12
10
I
Time spent - Lust session (minutes)
Upto 15
16-30
31-45
46+
Can’t sav-
5
20
4
62
10
5
19
2
63
10
Issues discussed n
Food & Nutrition
Immunisation
Growth monitoring
Breast feeding
AN & PN services
FP
Hygiene/Sanitation
IGA
Referral services
81
62
19
15
18
17
8
6
9
74 (z “3.80)*
65
11 (z-4 99)*
12
21
19
10
6
6
282
226
I
Total No. of mothers with < 6 yrs child reporting
NHED sessions by AWW
I
D Total exceeds 100 due to multiple response
* Significant at 5?4> level of significance
(
11
90
■r
Table 11.2d Use of Aids (Mother's response)
(% mothers)
________ Centres with
Trained AWW Untrained AWW
Whether used AV aids
Yes
No
Can’t say
61
37
2
62
33
5
Total No of mothers reporting NHED Sessions
by AWW
282
226
36
80
24
37
81
37
171
139
Type of aids used 0
Poster
Charts
Immunisation card
Total No of mothers reporting use of AV aids
by AWW_______________________________
0 Total exceeds 100 due to multiple response
J
11
M«M
91
113 INFANT AND CHILD DEATHS
■ f
On being asked about the post ICDS changes in the area, senior functionaries of
ICDS mentioned about teduction in infant and child deaths. Data relating to infant
and child deaths during 1996 and 1997 was collected from the senior officials
Analysis of this data is presented in Table 11.3a.
Table 11.3a Reduction in Infant and Child Deaths (1996-1997)
Extent ofarduction
< 25% .... ........
25 - 49%
50 - 74%
75 - 99%
____
Total No. of Functionaries
F
(
(f
(% Ftmci i onari cn)
Child deaths
1
9
22
48
Infant deaths
13
27
35
25
21
99
About one fifth to one fourth of the functionaries reported more than 75 per cent
reduction in child deaths and infant deaths More than half (60 to 69 per cent) of
the functionaries reported that the infant and child deaths have reduced by more
than 50 per cent during 1996 - 1997. This illustrates the impact of ICDS on infant,
and child deaths in the study area.
11
92
1 L4 RECORDING WORK
Maintenance of different registers is another job responsibility of the AWWs. The
AViAVs need to maintain 17 registers Attempts were made in the study to tind out
the extent of awareness of die different registers among the AWWs, availability of
the registers and frequency of updating.
Awareness
To begin with, all the AWWs were asked to list out the different registers they are
supposed to maintain. These responses were considered to get the level of
spontaneous awareness. Then for each of the registers not mentioned by the
AWW, the interviewer asked the AWW whether she is aware of the register. This
informatian gives us the aided awareness of the register. Table 11.4a gives the
levels of spontaneous and aided awareness of tire different registers among die
AWWs.
*
Sporrtaneouii awareness levels were high for most of the registers. And upon
aiding, ail tiic AWWs reported diat they are aware of almost ail the registers.
Levels of spontaneous awareness about some of the registers like Survey, Growth
Charts, Food Stock and Distribution etc. were noticed to be higher among the
trained AWWs compared to the untrained AWWs.
11
M*9b
93
•7
Table 11.4a Awareness about registers
(% AWWs)
________ Trained
! Spontaneous
Aided
Register
Untrained,
- ———---------------
Spontaneous
Aided
Survey
74
26
71
29
Growth Chart
62
38
56
44
Bcncf. Attendance
90
10
91
9
67
31
60
36
62
37
60
39
70
28
67
31
Staff attendance
82
18
84
16
Medicine stock
48
51
46
52
Heald} inspection
50
49
50
48
Reg. of birth
68
31
68
31
Reg. of pregnant women
67
33
66
33
Mothers sessions
61
38
56
43
Nutrition food camp
38
54
31
56
Reg. of deaths
75
25
72
27
Referral services
69
31
64
35
23
33
18
31
54
31____
54
i
Food stock/distnbution
Reg. of beneficiaries
Immunisation
Advisory committee
i
f
Permanent stock register
36
Total No. of AWWs
1485
Note : Total exceeds 100 due to multiple response
1180
u
94
Maintetinnce
All the AWWs were asked about the registers they were actually maintaining at the
time of the survey. The presence of the register was physically verified by the field
teams at each AWC. Analysis of this dara is presented in Table 11.4b.
Most of the registers were maintained by almost ail the AWWs. Survey register.
Beneficiary attendance. Food stock & distribution. Immunisation, Staff attendance
and Registration of births were some of the registers maintained by 97 to 98
per cent of the trained AWWs.
Proportion of AWWs maintaining each of the registers was higher among (he
trained AWWs, compared to their counterparts who could nor receive the
refresher training. And in most of the cases, the difference was found to be
statistically significant at 5% level of significance.
Table 11.4b Maintenance of P^egisters
Register_____
Survey
Growth chart
Benef. Attendance
Food stock and distribution
Reg of beneficiaries
Immunisation
Sialf attendance
Medicine stock
Health inspection
Reg. of births
Reg. of Pregnant women
Mother sessions
j Nutrition food camp
I Reg. of deaths
Referral services
Advisory committee
j Permanent stock reg.
7
i
I
i
(t
f
(
I
I
't
[
/
I
i
f
Trained
97
91
98
97
95
97
98
89
90
97
95
90
85
91
90
84
86
(%AWWs^
__ L) ntrained__
’ 94 (z« 7.90)* ’
85 (z. "-= 7.93)*
97
93 (z"9.47)*
92 (z-6.07)* (
94 (z-7.11)*
97
85(z = 6.14)*
83 (z« 10.41)*
94 (z-* 7 10)*
91 (z - 32.37)*
i 85 (z-7.94)*
80 (z-6 8 7)* f
86 (z-7.94)* i(
88
j
79
79
i
1485
i
I
((
(
[ Total No. of AWWs_________________
* Significant at 5% level of significance
Note : Total exceeds 100 due to multiple response
1180
Fig.TI.5 Registers Maintained by AWWs
% AWWs Maintaining
120 j.----------- -------------------------
ico L
97
&4+-
?7
•
—85 +
94+
i
85
i
i
f
l
i
J
40 H
------- .
i
eo Ir
60 r
91
ZJ
i
I
86+
I
I
I
20 r
<i
■b
0 LSurvey
Growth
Chart
IrniMunl
nation
Rsg.of
Beneflciartes
Register
[—] Trained
Untrained
+ Significant at 5% level of significance
Reg. of
Don th a
H
9$
On fee basis of fee results discussed above, it can be concluded feat fee trained
AWWs were able to perform fee task of maintenance of the registers in a better
wav'. On being asked about the benefits derived from fee refresher training,
AWs, Supervisors, CDPOs, and AWTC .staff invariably reported about the
improvement in skill of fee AWWs relating to the recording work. The trained
AWWs were able to rectify their mistakes in fee recording work, became
confident about their ability to maintain the registers and were making efforts to do
fee recording work properly (wife enhanced interest).
The difference between fee trained and untrained AWWs was visible in terms of
their response regarding fee perceived problems and suggestions for improvement
in fee context of fee recording work. For instance, 21% of fee untrained AWWs
reported lack of knowledge/understanding as a problem against 10% of the trained
AWWs. Heavy workload was mentioned more often by fee trained AWWs
(31 %). Problems relating to supply of new printed registers was cited by about
one fifth of fee trained as well as fee untrained AWs.
Some of fee suggestions put forth by fee AWs to ensure regular updating of die
registers include;
• Reducing fee number of registers to be maintained (33% trained and 29%
untrained AWWs)
• Training i‘ guidance / inputs regarding maintenance of fee registers (22%
trained and 35% untrained AWs)
• Regular supply of new printed registers (22% trained and 19%. untrained
AWWs)
Some of fee registers contain similar kind of information and the workload can be
reduced by decreasing the number of registers to be maintained by tiic AWWs.
Similar exercise was carried out by MODE for the World Bank assisted ICDS
Project in Andhra Pradesh under fee OR Study. As a result of fee OR exercise,
fee number of registers to be maintained in fee project area got reduced from 23 to
6. And this was found to be yielding encouraging results in regular maintenance of
fee registers by fee AWWs. Perhaps tills kind of exercise can be taken up in
Karnataka also to improve fee situation further through reduction in fee workload
and providing more guidance.
Short term training (say for 2-3 days) can be organised at fee sector / block level
on fee new set of the revised registers to make the AWWs competent to do their
recording work properly Or alternatively, fee Supervisor can give fee necessary
inputs during the .setrioi meeting to fee needy AXXAVs regarding fee recording
work.
u
96
(
1L5 SUPERVISION
■!
Effective supervision is a crucial input for improving the perfonnancc of the
grassroot level workers. Supervision is considered as a way to provide guidance
and support to the needy and deficient AWWs.
.‘Ml the AWWs were asked about the frequency of the supervisor’s visit, time spent
and activities carried out bv the supervisor.
The results are presented in
Tabic 11.5a.
About 65 per cent of the AWCs are usually visited by the Supervisor every month
(as envisaged in the project documents). Supervisors usually visit about 13-15 per
cent of the centres in their area once in 4-6 months only. The responses relating
to the general practice as well as the last visit indicate less frequent supervisory
visits. Tliis was mainly due to vacancy of the supervisor posts resulting in one
supervisor taking care of even 2 to 3 sectors. This makes it almost impossible for
the Supervisor to visit each centre of her sector every month. Poor transportation
and heavy workload also add to the problem.
About half of the AWWs - 45% trained and 59% untrained reported that their
supervisor spent about I hour nt their centre during the last visit Checking of the
registers and food stock, and observing the pre school session were the major
activities earned out by tire supervisor. The Supervisors who spend more lime at
the centre could carry out other activities like clearing doubts, house visits and
attending meetings.
All the Supervisors interviewed in the study were also asked about their visits to
the AW centres of their sector. About one third of the Supervisors reported that
they usually visit each centre every month. Z.ess than one fifth (17 per cent) of the
Supervisors reported that they visit each of the centres in their area once in 4-6
months. The stated response of the Supervisors were in line with that of the
AWWs. Reasons cited for less frequent visits to the AW centres include heavy
workload due to additional sectors and lack of transport facilities.
By and large, the Supervisors visit upto 3 centres in a day (79^b) with about one
fifth of the Supervisors visiting 4-6 centres in a day.
97
M*M
The activities earned out by the .Supervisors during their visit to AWC include :
- Checking of the registers ( 86%)
- Checking the food stock (69%)
- Observing tire pre school sessions (62%)
Rest of the activities like meeting community leaders ! mothers and attending
meetings were mentioned by less than one third of the supervisors.
Table 11.5a Yjgite.by.Sup.CTvis.or (AWW’s Response)
___ (% AWWs)
Unli mned
Trained
Frequency
Ever/ month
Once in 2-3 months
Once in 4-6 months/rarely
66
19
15
Last visit
Upto t month ago
2-3 months ago
4+ months ago
(f
1
)
Time spent
< Ihr
1 hr
2-3 hrs
4-6 hrs
No response
Activities0
Checked register-i
Observed pre school
I Checked food stock
Cleared doubts
House visits
Attended meetings
I Total No. of A WAVs
EJ Total exceeds 100 due to multiple response
(
I
f
i
ii
r
i
i
i
65
'll
13
59
24
16
!
58
26
16
18
27
38
12
4
27
30
32
7
4
90
66
64
35
15
11
91
62
64
36
12
9
1485
II
(
/i
1180
s
(
I
f
/
I
f
1
98
To sum up
MMi
!
Almost all the AWWs were providing Nutrition and Health Education through
house visits as well as group sessions. AWWs who received the innovative
refresher Training were able to provide NEED through regular house visits and
group sessions. Performance of the trained AWWs was better m terms of use of
audio visual aids and frequency of organising NEED sessions. Above findings
were corroborated by the participant observation of the AWCs carried out during
tlie field work.
As regards the recording work, AWWs who received the refresher training were
able to perform well while the AWWs who did not receive the refresher training
were not able to do so mainly due to lack of knowledge / understanding.
However, there is a need to have a retook at the various registers maintained by the
j\WW so as to reduce her workload.
Supervision needs to be improved and made effective by filling up the vacant
supervise posts or assigning the responsibility of supervision to senior
funcuonanes / officials of the Department of Women and Child Development or
AWTC.
u
99
CHAPTER 12
CONCLUSIONS AND SUGGESTIONS
u
100
12.1 CONCLUSIONS
M«9b
On the basis of the findings presented in the earlier sections, the following
conclusions can be made about the impact of the innovative refresher training
imparted to the AWWs during 1994 - 1997 :
*
Health and nutrition status of the children below 6 years of age was better
among the children from the centres with trained AWWs. The study brings
out higher levels of immunisation coverage (especially m case of Measles
and Vitamin A drops) and lower levels of malnutrition (grade III & IV)
among the children from the centres with trained AWWs. Effective referral
scrvicces, regular weighing of die children and better post weighing
interaction between the AWW and mothers regarding the kind of care to l>e
taken and food to be given were also observed in the centres with trained
AWWs.
*
Schooling status of the children of 6-14 years of age was belter in (he
villages with trained AWWs. Increase in primary school enrolliucnl was
reported by the mothers and community leaders more often in these villages.
File performance of the trained AWWs in terms of organising rcgultu' pre
school sessions, use of integr ated approach and pre school aids so as to
make the sessions more interesting and useful was observed to be better.
*
Levels of knowledge and awareness about the health and child care
practices were significantly higher among the mothers from the centres with
trained AWWs. Specifically, extent of awareness as well as utilisation of
services like child immunisation (Measles and Vitamin A drops), IT
(Pregnant Women), Health Checkups (Pregant Women), Referral Services
(Children), Supplementary Food and Growth Monitoring was obser ved to
be significantly higher among the mothers from the cetnres with trained
AWWs. Efforts from the trained AWWs to create more awareness among
the mothers through regular house visits and NHED sessions could have
paved the way for the improvement in the knowledge and awareness of the
mothers.
11
101
M*M
■1
*
The AWWs (trained as well as untrained) participate actively in the activities
of other departments providing the supportive services like Literacy, Health,
Education, DWCRA, MSY etc.
Hie AWWs were able to get tire cooperation of other departments like
Health (immunisation, health checkups, referrals), Education (AWC
building) and Panchayat / BDO (building, fuel expenses). The coordination
between the ICDS ;ind other departments was noticed to be of higher order
4c
The trained AWWs provided better picture in terms of community
participation, fhc extent of involvement of community leaders, mothem
and mahiia mandid members in AWC activities was significantly higher in
the centres with trained AWWs. Improvement in convincing ability as well
as communication skill and enhanced interest to perform better could be
considered as the factors responsible for higher levels of community
participation in the centres with trained AWWs.
4*
The trained AWWs Avere able to perform better in providing the basic
services regularly, properly efficiently and effectively (eg. InunniNiition
coverage. Use of integrated approach for pre school,. Periodic weighing, lh e
school. Preparation of pre school aids, NHED, Recording work etc ).
CH-
07492
r(
XO14
11
102
Impact of I CDS
❖
ICDS has helped in improving the health and nutrition status of the children
below 6 years of age with better child care practices (eg. immunisation) and
lower levels of malnutrition
ITe study highlights the better schooling status of die children of 6-14- years
in the study area
J{c
ICDS has contributed to better knowledge and awareness about health and
cluld care practices (eg. Immunisation, supplementary feeding, growth
monitoring etc.) among the mothers of 0-6 years child. This was achieved
through regular and effective NHED programmes carried out by the
AWWs.
*
The study highlights greater community paniciparion as well as convergence
of services which again can be considered as a contribution of the ICDS
programme.
1
103
12.2 SUGGESTIONS
Suggestions for further improvement in the innovative refresher training
programme are as follows :
*
More time be allocated for group discussions during the training
*
More use of audio visual aids for imparting the training
*
Reduction of the batch size of trainees (AWWs) to 10-15 so as to make the
interaction more effective.
•r»
Supply of all the materials during/after the training to die AWWs.
*
Greater attention towards follow up after the training (by the trainers) to
assess the post training changes.
Suggestions for further improvement in the ICDS programme or service delivery
are :
Make the recruitment policy completely free from poiihcai interference to
ensure selection of the needy, dedicated and local women.
*
Pilling up all vacant posts - eg. Supervisor. MO.
*
Reduction in the number of registers to be maintained.
*
Regular supply of printed registers.
*
Regular review meetings of functionaries of ICDS and other depai imenis al
distnct/bloek level.
*
Joint supervision / joint visits by the officials of ICDS and other depai tnicnti*
(to the AWCs).
*
Provision of vehicle to the officials of other departments for joint visits (eg
to the MO for attending sector or project meetings).
*
Responsibility of supervision can be given to the AWTC staff or otiiei senior
functionaries of ICDS to ensure effective supervision.
*
Follow up of die immunisation dropouts to ensure completion of the full
schedule (eg. all doses of OPV, DPT and Vitamin A).
I i
’04
Timeiy food suppty (preferably through single supplying agency) to avoid
interruption and ensure feeding for ail the 25 days in a montir
*
More priority be given to growth monitoring in the NHED (through group
sessions as well as house visits) so as to sensitise the mothers about regular
periodic weighing of the children.
*
Timely supply of the weighing scales to the AW Centres.
*
More emphasis to involve the local (trained) dais in conducting deliveries.
*
Sensitisation of the community leaders and mothers about K'DS, its
importance and usefulness for the village (through sector and village level
sessions).
Position: 3756 (2 views)